Abstract
Objective
This study aims to report the results of locking compression plate along with intramedullary fibular graft that was implemented in patients with the diagnosis of nonunion of humerus diaphysis.
Materials and methods
Five patients, operated between 2000 and 2009 for atrophic type nonunion of humeral diaphysis, were included in this study. Two patients were women (40%) and three were men (60%). The mean age was 49.2 years. Nonunion was found to be on the right humerus of 3 patients and on the left side of 2 patients. Causes of fractures were traffic accident in 2 cases, simple fall in 2 cases, and fall from height in 1 case. Mean duration after the elementary fracture was 70 months. Nonunion was diagnosed at 1/3 proximal humeral diaphysis in 2 patients, 1/3 distal humeral diaphysis in 2 patients, and 1/3 middle humeral diaphysis in one patient. Initially, conservative treatment was chosen for 3 cases and plate-screw osteosynthesis for 2 cases.
Results
Complete union was obtained in all cases radiologically. Mean union time was 20.1 weeks. With a mean of 1.78 cm, shortening was detected in comparative radiographies of both humeri. Mean range of motion at the elbow was 118° in flexion–extension arch of patients. The mean Constant-Murley score was 88 points. There was no complication regarding the operation and graft donor sites.
Conclusion
The management of atrophic type humeral nonunions is difficult. The method that we practice in such patients is a reliable treatment option with its stabile fixation and high union rates.
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References
Volgas DA, Stannard JP, Alonso JE (2004) Nonunions of the humerus. Clin Orthop Relat Res 419:46–50
Ring D, Kloen P, Kadzielski J et al (2004) Locking compression plates for osteoporotic nonunions of the diaphyseal humerus. Clin Orthop Relat Res 425:50–54
Epps CH Jr, Grant RE (1991) Fractures of the shaft of the humerus. In: Rockwood CA Jr, Green DP, Bucholz RW (eds) Rockwood and Green’s fractures in adults, vol 1, 3rd edn. J. B. Lippincott, Philadelphia, pp 843–869
Micic I, Mitkovic M, Mladenovic D, Stanojlovic M, Jeon IH (2007) Treatment of the humeral shaft nonunion after surgical failure using the Selfdynamisable internal fixator. Arch Orthop Trauma Surg 127(8):713–718
Marinelli A, Antonioli D, Guerra E, Bettelli G, Zaccarelli L, Rotini R (2009) Humeral shaft aseptic nonunion: treatment with opposite cortical allograft struts. Chir Organi Mov 93(Suppl 1):21–28
Atalar AC, Kocaoglu M, Demirhan M, Bilsel K, Eralp L (2008) Comparison of three different treatment modalities in the management of humeral shaft nonunions (plates, unilateral, and circular external fixators). J Orthop Trauma 22(4):248–257
Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164
Oztürk I, Ertürer E, Uzun M, Akman S, Seçkin F (2006) The effectiveness of functional bracing in the conservative treatment of humeral diaphyseal fractures. Acta Orthop Traumatol Turc 40(4):269–273
Balfour GW, Mooney V, Ashby ME (1982) Diaphyseal fractures of the humerus treated with a ready-made fracture brace. J Bone Joint Surg (Am) 64(A):11–13
Pugh DM, McKee MD (2003) Advances in the management of humeral nonunion. J Am Acad Orthop Surg 11(1):48–59
Vidyadhara S, Vamsi K, Rao SK, Gnanadoss JJ, Pandian S (2009) Use of intramedullary fibular strut graft: a novel adjunct to plating in the treatment of osteoporotic humeral shaft nonunion. Int Orthop 33(4):1009–1014
Hierholzer C, Sama D, Toro JB et al (2006) Plate fixation of ununited humeral shaft fractures: effect of type of bone graft on healing. J Bone Joint Surg (Am) 88(7):1442–1447
Van Houwelingen AP, McKee MD (2005) Treatment of osteopenic humeral shaft nonunion with compression plating, humeral cortical allograft struts, and bone grafting. J Orthop Trauma 19(1):36–42
Borus TA, Yian EH, Karunakar MA (2005) A case series and review of salvage surgery for refractory humeral shaft nonunion following two or more prior surgical procedures. Iowa Orthop J. 25:194–199
Rubel IF, Kloen P, Campbell D et al (2002) Open Reduction and internal fixation of humeral nonunions. J Bone Joint Surg (Am) 84(A):1315–1322
Nadkarni B, Srivastav S, Mittal V, Agarwal S (2008) Use of locking compression plates for long bone nonunions without removing existing intramedullary nail: review of literature and our experience. J Trauma 65(2):482–486
Martinez AA, Cuenca J, Herrera A (2004) Treatment of humeral shaft nonunions: nailing versus plating. Arch Orthop Trauma Surg 124(2):92–95
Wu CC, Shih CH (1992) Treatment for non-union of the shaft of the humerus: comparison of plates and Seidel interlocking nails. Can J Surg 35(6):661–665
Lammens J, Baudin G, Driessen R et al (1998) Treatment of nonunion of the humerus using the Ilizarov external fixator. Clin Orthop Relat Res 353:223–230
Wright TW, Miller GJ, Vander Griend RA, Wheeler D, Dell PC (1993) Reconstruction of the humerus with an intramedullary fibular graft. A clinical and biomechanical study. J Bone Joint Surg (Br) 75(5):804–807
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No funds were received in support of this study. The author(s) of this manuscript has/have chosen not to furnish Ejost and its readers with information regarding any relationship that might exist between a commercial party and material contained in this manuscript that might represent a potential conflict of interest. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
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Erden, E.R., Arda, C., Mesut, S.M. et al. Implementation of locking compression plate together with intramedullary fibular graft in atrophic type humeral nonunions. Eur J Orthop Surg Traumatol 22, 661–665 (2012). https://doi.org/10.1007/s00590-011-0900-0
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DOI: https://doi.org/10.1007/s00590-011-0900-0