Skip to main content
SpringerLink
Log in

Single versus double plate fixation of humeral shaft nonunion

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Humeral shaft fractures are common fractures of the diaphysis of the humerus. The aim of this study was to evaluate factors affecting the clinical outcomes of humeral nonunions surgically treated with open reduction and single- versus double-plate fixation with grafting.

Materials and methods

A total of 31 patients with nonunion treated with single- or double-plate screw fixation with bone grafting were retrospectively analysed. The patients were divided into two groups according to the treatment method as Group 1 (single-plate, n = 14) and Group 2 (double-plate, n = 17). Data including demographic and clinical characteristics of the patients, initial and final treatment, type of nonunion and localisation, graft use, shortening, follow-up, time to union, Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) scores, and patient-reported cosmetic outcomes were recorded.

Results

Of the patients, eight were males, and 23 were females, with a mean age of 47.6 ± 15.8 (range, 20–86) years. Initial treatment was conservative treatment (Sarmiento brace) in seven patients, plate fixation in 22 patients, and intramedullary nailing in two patients. The mean follow-up was 31.0 ± 16.9 months in Group 1 and 25.4 ± 15.6 months in Group 2. There was one nonunion in Group 1 and three in Group 2. There were no significant differences in the union rate and time to union (p = 0.378 and p = 0.262, respectively). The mean Quick-DASH scores and cosmetic results were similar between the groups (p = 0.423 and p = 0.165, respectively). Radial nerve palsy developed in three patients in Group 2, and all these patients recovered completely during follow-up.

Conclusions

Although the double-plate fixation technique has similar clinical, radiological, and functional results to single-plate fixation, it is a more invasive and expensive technique with a longer operation time. Therefore, it should not be used as the first-line treatment option for all humeral shaft nonunion. Nevertheless, the double-plate technique may be preferred to achieve in cases requiring high stability, such as hypertrophic nonunion, osteopenia and comminuted fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availablility

Data available on request from the authors.

References

  1. Tannura ARH, Oliviera DJ, Barros JW (2002) Treatment of humeral shaft pseudarthrosis with a compression 3,5 mm AO plate plus thoracobrachial plaster cast. Acta Ortop Bras 10:5–9

    Article  Google Scholar 

  2. Allende C, Allende BT (2009) The use of a new locking 90 degree blade plate in the treatment of atrophic proximal humerus nonunions. Int Orthop 33:1649–1654

    Article  PubMed  Google Scholar 

  3. Baksi DP, Pal AK, Baksi D (2011) Prosthetic replacement of elbow for intercondylar fractures (recent or ununited) of humerus in the elderly. Int Orthop 35:1171–1177

    Article  PubMed  Google Scholar 

  4. Kontakis GM, Tosounidis T, Pagkalos J (2007) Humeral diaphyseal aseptic nonunions: an algorithm of management. Injury 38(Suppl 2):S39–S49

    Article  PubMed  Google Scholar 

  5. Denard A Jr, Richards JE, Obremskey WT et al (2010) Outcome of nonoperative vs operative treatment of humeral shaft fractures: a retrospective study of 213 patients. Orthopedics. https://doi.org/10.3928/01477447-20100625-16

    Article  PubMed  Google Scholar 

  6. Rubel IF, Kloen P, Campbell D et al (2002) Open reduction and internal fixation of humeral nonunions: a biomechanical and clinical study. J Bone Joint Surg Am 84:1315–1322

    Article  PubMed  Google Scholar 

  7. Volgas DA, Stannard JP, Alonso JE (2004) Nonunions of the humerus. Clin Orthop Relat Res 419:46–50

    Article  Google Scholar 

  8. Koutalos A, Varitimidis S, Dailiana Z, Bargiotas K, Koutsogiannis A, Malizos KN (2015) Operative management of humeral nonunions, Factors that influence the outcome. Acta Orthop Belg 81(3):501–10

    PubMed  Google Scholar 

  9. Healy WL, White GM, Mick CA et al (1987) Nonunion of the humeral shaft. Clin Orthop Relat Res 219:206–213

    Article  Google Scholar 

  10. Pugh DM, McKee MD (2003) Advances in the management of humeral nonunion. J Am Acad Orthop Surg 11:48–59

    Article  PubMed  Google Scholar 

  11. Naclerio EH, McKee MD (2022) Approach to humeral shaft nonunion: evaluation and surgical techniques. J Am Acad Orthop Surg 30(2):50–59. https://doi.org/10.5435/JAAOS-D-21-00634

    Article  PubMed  Google Scholar 

  12. Anglen JO, Archdeacon MT, Cannada LK, Herscovici D Jr (2008) Avoiding complications in the treatment of humeral fractures. J Bone Joint Surg Am 90(7):1580–1589

    PubMed  Google Scholar 

  13. Martinez AA, Herrera A, Pérez JM, Cuença J, Martinez J (2001) Treatment of humeral shaft non union by external fixation: a valuable option. J Orthop Sci 6:238–241

    Article  PubMed  Google Scholar 

  14. Christensen NO (1976) Kuntscher intramedullary reaming and nail fixation for nonunion of the humerus. Clin Orthop Relat Res 116:222–225

    Google Scholar 

  15. McKee MD, Miranda MA, Riemer BL et al (1996) Management of humeral nonunion after the failure of locking intramedullary nails. J Orthop Trauma 10(7):492–499

    Article  CAS  PubMed  Google Scholar 

  16. Gautier E, Sommer C (2003) Guidelines for the clinical application of the LCP. Injury 34(Suppl 2):63–76

    Article  Google Scholar 

  17. Tan SL, Balogh ZJ (2009) Indications and limitations of locked plating. Injury 40(7):683–691

    Article  PubMed  Google Scholar 

  18. Verbruggen JP, Sternstein W, Blum J, Rommens PM, Stapert JW (2007) Compression locked nailing of the humerus: a mechanical. Acta Orthop 78:143–150

    Article  PubMed  Google Scholar 

  19. Karakasli A, Basci O, Ertem F, Sekik E, Havitcioglu H (2016) Dual plating for fixation of humeral shaft fractures: a mechanical comparison of various combinations of plate lengths. Acta Orthop Traumatol Turc 50(4):432–436

    Article  PubMed  PubMed Central  Google Scholar 

  20. Tecimel O, Bozkurt İ, Çepni Ş, Yaman F, Fırat A, Öçgüder DA (2021) The comparison of single plate and double plate fixation methods for treatment of humeral shaft nonunions. Jt Dis Relat Surg 32(1):67–74

    PubMed  PubMed Central  Google Scholar 

  21. Nadler SB, Hidalgo JH, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51(2):224–232

    PubMed  Google Scholar 

  22. Meunier A, Petersson A, Good L, Berlin G (2008) Validation of a haemoglobin dilution method for estimation of blood loss. Vox Sang 95(2):120–124. https://doi.org/10.1111/j.1423-0410.2008.01071.x

    Article  CAS  PubMed  Google Scholar 

  23. Beaton DE, Davis AM, Hudak P, McConnell S (2001) The DASH (disabilities of the arm, shoulder and hand) outcome measure: what do we know about it now? Brit J Hand Ther 6(4):109–118

    Article  Google Scholar 

  24. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF (2018) Fracture and dislocation classification compendium-2018. J Orthop Trauma 32(Suppl 1):S1–S170. https://doi.org/10.1097/BOT.0000000000001063

    Article  PubMed  Google Scholar 

  25. Robinson CM, Bell KM, Curt Brown CM, McQueen MM (1992) Locked nailing of humeral shaft fractures. J Bone Joint Surg Br 74:558–562

    Article  CAS  PubMed  Google Scholar 

  26. Gogoua R, Traoré M, Yépié A, Kouamé M, Anoumou M (2017) Aseptic pseudoarthrosis of the humeral diaphysis. Epidemiological features—therapeutic assessment. Open J Orthoped 7:147–155. https://doi.org/10.4236/ojo.2017.76017

    Article  Google Scholar 

  27. Gessmann J, Konigshausen M, Coulibaly MO, Schildhauer TA, Seybold D (2016) Anterior augmentation plating of aseptic humeral shaft nonunions after intramedullary nailing. Arch Orthop Trauma Surg 136:631–638

    Article  PubMed  Google Scholar 

  28. Lammens J, Bauduin G, Driesen R et al (1998) Treatment of nonunion of the humerus using the Ilizarov external fixator. Clin Orthop Relat Res 353:223–230. https://doi.org/10.1097/00003086-199808000-00026

    Article  Google Scholar 

  29. Patel VR, Menon DK, Pool RD et al (2000) Nonunion of the humerus after failure of surgical treatment. Management using the Ilizarov circular fixator. J Bone Joint Surg (Br) 82(7):977–983. https://doi.org/10.1302/0301-620x.82b7.10180

    Article  CAS  PubMed  Google Scholar 

  30. Osman N, Touam C, Masmejean E, Asfazadourian H, Alnot JY (1998) Results of non-operative and operative treatment of humeral shaft fractures. A series of 104 cases. Chir Main 17(3):195–206. https://doi.org/10.1016/s0753-9053(98)80039-2

    Article  CAS  PubMed  Google Scholar 

  31. Kosmopoulos V, Nana AD (2014) Dual plating of humeral shaft fractures: orthogonal plates biomechanically outperform side-by-side plates. Clin Orthop Relat Res 472(4):1310–1317. https://doi.org/10.1007/s11999-013-3379-7

    Article  PubMed  Google Scholar 

  32. Martinez AA, Cuenca J, Herrera A (2009) Two-plate fixation for humeral shaft nonunions. J Orthop Surg 17(2):135–138

    Article  Google Scholar 

  33. Rubel IF, Kloen P, Campbell D, Schwartz M, Liew A, Myers E, Helfet DL (2002) Open reduction and internal fixation of humeral nonunions: a biomechanical and clinical study. J Bone Joint Surg Am 84(8):1315–1322. https://doi.org/10.2106/00004623-200208000-00004

    Article  PubMed  Google Scholar 

  34. Watts A, Weinhold P, Kesler W, Dahners L (2012) A biomechanical comparison of short segment long bone fracture fixation techniques: single large fragment plate versus 2 small fragment plates. J Orthop Trauma 26:528–532

    Article  PubMed  Google Scholar 

  35. Koh J, Tornetta P 3rd, Walker B, Jones C, Sharmaa T, Sems S et al (2020) What is the real rate of radial nerve injury after humeral nonunion surgery? J Orthop Trauma 34:441–446. https://doi.org/10.1097/BOT.0000000000001755

    Article  PubMed  Google Scholar 

  36. Kakazu R, Dailey SK, Schroeder AJ, Wyrick JD, Archdeacon MT (2016) Iatrogenic radial nerve palsy after humeral shaft nonunion repair: more common than you think. J Orthop Trauma 30:256–261. https://doi.org/10.1097/BOT.0000000000000525

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to extend our thanks to Prof. Dr. Muzaffer Sindel for her valuable and constructive suggestions during the planning and development of this research work.

Funding

This study received no specific grant from any funding agency in the public, commercial or not‐for‐profit sectors.

Author information

Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Medical Faculty, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey

    Melih Unal, Yusuf Alper Katı, Baver Acar, Adil Turan & Halil Yalçın Yuksel

  2. Department of Anatomy, Medical Faculty, Akdeniz University, Antalya, Turkey

    Serra Ozturk

Authors
  1. Melih Unal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yusuf Alper Katı
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Baver Acar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adil Turan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Serra Ozturk
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Halil Yalçın Yuksel
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design: MU, YAK, acquisition of data: MU, BA, AT. Analysis and interpretation of data: SO, MU, drafting of manuscript: MU, YAK, critical revision: YAK, HYY. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yusuf Alper Katı.

Ethics declarations

Conflict of interest

Authors have no conflict of interest to declare.

Ethical approval

This study was approved by the Antalya Training and Research Hospital Institutional Review Board with the Approval No: 28.12.2022/773. The study was conducted in accordance with the principles of the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study. Patients signed informed consent regarding publishing their data and photographs.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Unal, M., Katı, Y.A., Acar, B. et al. Single versus double plate fixation of humeral shaft nonunion. Arch Orthop Trauma Surg 144, 693–699 (2024). https://doi.org/10.1007/s00402-023-05111-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-023-05111-6

Keywords

Search

Navigation