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Management of humeral nonunions following failed surgical fixation

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

Abstract

Introduction

Management of humerus nonunions with previously failed fixation presents a complex problem. There are multiple revision fixation strategies, of which compression plating is a mainstay. The aim of this study was to assess the results of open reduction and direct compression plating without the need for autograft or allograft in the setting of revision humerus open reduction internal fixation.

Methods

This study is a retrospective analysis of 19 patients treated between 2008 and 2017 for humerus nonunions following failed fixation who were treated by a single surgeon using direct compression plating with bone graft substitutes. Patients were treated with neurolysis of the radial nerve, hardware removal, debridement of the nonunion site with shortening osteotomies, compression plating, and augmentation with bone graft substitutes. All patients were followed until radiographic and clinical union.

Results

Nineteen patients were identified for the study and 17 had adequate follow-up for final analysis. Humeral union was achieved in 16/17 (94.1%) patients with a mean time to union of 23 weeks. Two patients required a repeat compression plating with bone graft substitute to achieve union. The one patient with a nonunion radiographically reported minimal clinical symptoms and opted for no revision surgery. An association with the index procedure was seen, as three out of four of the patients who experienced radial nerve palsies after their index procedure subsequently experienced a radial nerve palsy after the procedure to repair their nonunion. All patient’s all experienced a return of function in their radial nerve either back to baseline or improved from before the revision nonunion surgery.

Conclusion

The use of humeral shortening osteotomy and compression plating without autograft or allograft is a viable option for management of humeral nonunions which avoids the morbidity associated with autograft harvest. The patients with radial nerve palsy after the index procedure are likely to have a transient radial nerve palsy as well after the revision surgery necessitating proper informed consent prior to the operation.

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Authors and Affiliations

  1. Department of Orthopedics, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MC 7774, San Antonio, TX, 78229-3900, USA

    Andrew Lee, Trevor Wait, Kush Shah, Uchechukwuka Osadebe, Matthew Kergosien & Anil Dutta

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  1. Andrew Lee
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  2. Trevor Wait
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Correspondence to Andrew Lee.

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Based on IRB approval, no informed consent was obtained for this retrospective study.

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Lee, A., Wait, T., Shah, K. et al. Management of humeral nonunions following failed surgical fixation. Arch Orthop Trauma Surg 142, 401–408 (2022). https://doi.org/10.1007/s00402-020-03577-2

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