Abstract
Introduction
Fractures of the humeral shaft are relatively common injuries and the majority achieve union uneventfully; however, non-union rates of up to 13% are reported when managed either conservatively or operatively. Despite the many surgical techniques described for the management of non-unions, including plate fixation, intramedullary nailing or external fixation, some cases remain resistant to treatment with ongoing problems achieving union.
Method
We describe a technique using the Stryker T2™ humeral nail which incorporates a compression system allowing closure of the non-union fracture gap. Twelve patients underwent compression nailing for established humeral fracture non-union. All achieved radiological union at an average of 4.5 months (range 3–12 months).
Results
All patients reported a return to their normal pre-injury level of activities.
Conclusion
We conclude that this technique of intramedullary nailing with a novel compression technique is effective in the treatment of humeral shaft fracture non-union.
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References
Sarmiento A, Zagorski JB, Zich GA et al (2000) Functional bracing for the treatment of fractures of humeral Diaphyses. J Bone Joint Surg Am 82:478–486
Ring D, Perey BH, Jupiter JB (1999) The functional outcome of operative treatment of ununited fractures of the humeral diaphyses in older patients. J Bone Joint Surg Am 81:177–190
Green E, Lubahn JD, Evans J (2005) Risk factors, treatment and outcomes associated with nonunion of the midshaft humerus fracture. J Surg Orthop Adv 14(2):64–72
Healy WL, White GM, Mick CA et al (1987) Nonunion of the humeral shaft. Clin Orthop 219:206–213
McKnee MD, Miranda MA, Riemer BL et al (1996) Management of humeral nonunion after failure of locking intramedullary nails. J Orthop Trauma 10:492–499
Pritchett JW (1985) Delayed union of humeral shaft fractures treated by closed flexible intramedullary nailing. J Bone Joint Surg Br 67:715–718
Barquet A, Fernandez A, Luvizio J et al (1989) A combined therapeutic protocol for aseptic nonunion of the humeral shaft. J Trauma 29:95–98
Chen CY, Ueng SW, Shih SH (1997) Staged management of infected humeral nonunion. J Trauma 43:793–798
Loomer R, Kokan P (1976) Nonunion in fractures of the humeral shaft. Injury 7:274–278
Lin J, Chiang H (2002) Chang DS: locked nailing with interfragmentary wiring for humeral nonunions. J Trauma 52:733–738
Dawson J, Fitzpatrick R, Carr A (1996) Questionnaire on the perceptions of patients about shoulder surgery. J Bone Joint Surg Br 78(4):593–600
Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164
Yian EH, Ramappa AJ et al (2005) The Constant score in normal shoulders. J Should Elbow Surg 14(2):128–133
Blum J, Machemer H, Hogner M et al (2000) Biomechanics of interlocked nailing in humeral shaft fractures: comparison of two nail systems and the effect of interfragmentary compression with unreamed humeral nail. Unfallchirurg 103:183–190
Patel VR, Menon DK, Pool RD et al (2000) Nonunion of the humerus after failure of surgical treatment: management using the Ilizarov frame. J Bone Joint Surg (Br) 82-B:977–983
Wu CC (1996) Humeral shaft Nonunion treated by seidel interlocking nail with supplementary staple. Clin Orthop 326:202–208
Richardson T, Voor M, Selingson D (1998) Fracture site compression and motion with three types of intramedullary fixation of the femur. Osteosynthese Int 6:261–264
Pietu G, Raynaud G, Letenneur J (1994) Treatment of delayed and nonunions of the humeral shafts using the Seidel locking nail. J Orthop Trauma 8:240–244
Lin J, Hou SM, Hang YS (2000) Treatment of Humeral shaft delayed unions and nonunions with humeral Nails. J Trauma 48(4):695–703
Marti RK, Verheyen CC, Besselaar PP (2002) Humeral shaft nonunion: evaluation of uniform surgical repair in fifty-one patients. J Orthop Trauma 16(2):108–115
Volgas D, Stannard J, Alonso J (2004) Nonunions of the humerus. Clin Orthop 419:46–50
Kesemenli CC, Subasi M, Arslan H et al (2002) Treatment of humeral diaphyseal non-unions by interlocked nailing and autologous bone grafting. Acta Orthop Belg 68(5):471–475
Lammens J, Bauduin G, Driesen R et al (1998) Treatment of nonunion of the humerus using the Ilizarov external fixator. Clin Orthop 353:223–230
Muller ME (1965) Treatment of nonunions by compression. Clin Orthop 43:83–92
Mückley T, Diefenbeck M, Sorkin AT et al (2008) Results of the T2 humeral nailing system with special focus on compression interlocking. Injury 39:299–305
Ranieri L, Olmi R (1976) Nonunion of the humerus after internal fixation. Ital J Orthop Traumatol 2:51–55
Mueckley T, Gonschorek O, Buehren V (2003) Compression nailing of long bones. Eur J Trauma 29:113–128
Verbruggen JP, Sternstein W, Blum J, Rommens PM, Stapert JW (2007) Compression-locked nailing of the humerus: a mechanical analysis. Acta Orthop 78(1):143–150
Khan MS, Sahibzada AS, Khan MA et al (2005) Outcome of plating, bone grafting and shortening of humeral diaphyseal fracture. J Ayub Med Coll Abottabad 17(2):44–46
Kontakis GM, Papadokostakis GM, Alpantaki K et al (2006) Intramedullary nailing for non-union of the humeral diaphysis: a review. Injury 37(10):953–960
Dimitriou R, Dahabreh Z, Katsoulis E et al (2005) Application of recombinant BMP-7 on persistent upper and lower limb non-unions. Injury 36(Suppl 4):S51–S59
Yajima H, Maegawa N, ota H et al (2007) Treatment of persistent non-union of the humerus using a vascularized bone graft from the supracondylar region of the femur. J Reconstr Microsurg 23(2):107–113
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Fenton, P., Qureshi, F., Bejjanki, N. et al. Management of non-union of humeral fractures with the Stryker T2™ compression nail. Arch Orthop Trauma Surg 131, 79–84 (2011). https://doi.org/10.1007/s00402-010-1110-7
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DOI: https://doi.org/10.1007/s00402-010-1110-7