Treatment of Osteopenic Humeral Shaft Nonunion With Compression Plating, Humeral Cortical Allograft Struts, and Bone Grafting

Introduction. Although the recommended treatment for humeral shaft nonunion is compression plating with autologous bone grafting, we treated a case of humeral shaft nonunion with an intramedullary nail (IMN) without bone grafting. Presentation of Case. Osteosynthesis with IMN was performed on a 24-year-old man with a humeral shaft fracture at another hospital. However, bony union was not obtained 1 year after the first surgery, and he was referred to our institution. We treated the nonunion with exchange nailing without autologous bone grafting using compression function of the nail, leading to bony union at 7 months postoperatively. At the final follow-up 2 years and 4 months postoperatively, the patient had full range of motion in the left shoulder and elbow joints. Discussion. Compression plating with autologous bone grafting is reported to be the gold standard for the treatment of humeral shaft nonunion. IMN is advantageous for minimal invasion; however, the conventional type of IMN cannot apply compression force between fragments and does not have sufficient stability against rotational force. In this case, we used an IMN that could apply compression between the fragments and which had rotational stability via many screws. We did not perform bone grafting because the current nonunion was adjudged to be biologically active, and we achieved good functional results. Conclusion. We treated humeral shaft nonunion using IMN with compression, but without bone grafting, leading to successful clinical outcomes. This strategy might be an appropriate choice for the treatment of humeral shaft nonunion with biological activity.

Download Full-text

Locking compression plate in humeral shaft nonunion: a retrospective study of 18 cases

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20162822 ◽

2016 ◽

Vol 2 (3) ◽

pp. 86

Author(s):

Rajesh Govindasamy ◽

Ramkumar Gnanasundaram ◽

Saravanan Kasirajan ◽

Fawas Thonikadavath ◽

Jeff Walter Rajadurai

Keyword(s):

Bone Grafting ◽

Locking Compression Plate ◽

Humeral Shaft ◽

Radial Nerve Palsy ◽

Functional Evaluation ◽

Postoperative Function ◽

Non Union ◽

Humeral Shaft Nonunion ◽

Compression Plate ◽

The Mean

Background: Humeral shaft nonunions are frequently seen in Orthopaedic practice. Osteosynthesis with bone grafting is the treatment of choice. Locking compression plate (LCP) is the latest implant used in treating them. We retrospectively evaluated the outcome of use of LCP in humeral shaft non-union resulted by both conservative management and following failed internal fixations.Methods: Eighteen patients with nonunion of humeral shaft in which ten were treated by traditional bone setters and eight followed by failed internal fixation were included in these study. The mean duration of nonunion was 18.3 months (range 8-22). The mean follow up period was 18 months (range 12-26). The mean age of patients was 44.4 years (range 22-60). All patients underwent osteosynthesis with LCP and autologoous cortico-cancellous iliac crest graft. The outcome measures include radiographic assessment of fracture union and preoperative and postoperative function using modified constant and murley scoring system.Results: All fractures united following osteosyntesis average time for union was15 weeks (range 10-24). We did not have any delayed union or non-union. The complications were superficial infection (n=1) and wound haematoma (n=1).Three patients with preoperative radial nerve palsy recovered at the end of four months. Functional evaluation using constant-murley score showed excellent result in 14, good in 3 and fair in 1. We did not have any poor results.Conclusions: LCP with cancellous bone grafting is a safe reliable option for all forms of humeral shaft nonunion. We recommend it.

Download Full-text

Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03743-y ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Dongxu Feng ◽

Xiaolong Wang ◽

Liang Sun ◽

Xiao Cai ◽

Kun Zhang ◽

...

Keyword(s):

Bone Grafting ◽

Nerve Palsy ◽

Iliac Crest ◽

Humeral Shaft ◽

Autogenous Bone ◽

Salvage Procedure ◽

Iliac Crest Bone Grafting ◽

Ulnar Nerve Palsy ◽

Humeral Shaft Nonunion ◽

The Mean

Abstract Background Although most cases of humeral shaft nonunion respond well to surgical intervention, surgeons still encounter patients with humeral shaft nonunion who have already undergone repeated surgeries for nonunion. This study retrospectively analyzed the efficacy of double locking compression plate (LCP) fixation in combination with autogenous iliac crest bone grafting for recalcitrant humeral shaft nonunion. Methods A consecutive series of patients with aseptic recalcitrant humeral shaft nonunion underwent surgical treatment between May 2010 and August 2017 in our institution. Standardized treatment included thorough debridement, double LCP and screw fixation, and autogenous iliac bone grafting. The injury type and the duration of nonunion were recorded for all patients. The main outcome measurements were the Constant and Murley scale for shoulder function, Mayo elbow performance index (MEPI) for elbow function, and visual analog scale (VAS) for pain. In addition, all complications were documented. Results The study cohort comprised six females and nine males with a mean age of 45.3 ± 13.1 years. Each patient had already undergone at least one failed surgery for humeral shaft nonunion. The average duration of nonunion before the index intervention was 126.8 ± 124.2 months. All patients achieved bone union without implant failure. At final follow-up, the mean Constant and Murley score and mean MEPI were significantly improved, and the mean VAS score was significantly decreased. Each patient was very satisfied with the treatment. Four patients had complications, including one with a superficial wound infection, one with radial nerve palsy, one with ulnar nerve palsy, and one with discomfort at the iliac crest. Conclusion Double plate fixation combined with autogenous iliac crest bone grafting results in successful salvage of humeral shaft nonunion after prior failed surgical interventions.

Download Full-text

Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion

10.21203/rs.3.rs-34226/v3 ◽

2021 ◽

Author(s):

Dongxu Feng ◽

Xiaolong Wang ◽

Liang Sun ◽

Xiao Cai ◽

Kun Zhang ◽

...

Keyword(s):

Bone Grafting ◽

Nerve Palsy ◽

Iliac Crest ◽

Humeral Shaft ◽

Autogenous Bone ◽

Salvage Procedure ◽

Iliac Crest Bone Grafting ◽

Ulnar Nerve Palsy ◽

Humeral Shaft Nonunion ◽

The Mean

Abstract Background: Although most cases of humeral shaft nonunion respond well to surgical intervention, surgeons still encounter patients with humeral shaft nonunion who have already undergone repeated surgeries for nonunion. This study retrospectively analyzed the efficacy of double locking compression plate (LCP) fixation in combination with autogenous iliac crest bone grafting for recalcitrant humeral shaft nonunion.Methods: A consecutive series of patients with aseptic recalcitrant humeral shaft nonunion underwent surgical treatment between May 2010 and August 2017 in our institution. Standardized treatment included thorough debridement, double LCP and screw fixation, and autogenous iliac bone grafting. The injury type and the duration of nonunion were recorded for all patients. The main outcome measurements were the Constant and Murley scale for shoulder function, Mayo elbow performance index (MEPI) for elbow function, and visual analog scale (VAS) for pain. In addition, all complications were documented.Results: The study cohort comprised six females and nine males with a mean age of 45.3±13.1 years. Each patient had already undergone at least one failed surgery for humeral shaft nonunion. The average duration of nonunion before the index intervention was 126.8±124.2 months. All patients achieved bone union without implant failure. At final follow-up, the mean Constant and Murley score and mean MEPI were significantly improved, and the mean VAS score was significantly decreased. Each patient was very satisfied with the treatment. Four patients had complications, including one with a superficial wound infection, one with radial nerve palsy, one with ulnar nerve palsy, and one with discomfort at the iliac crest.Conclusion: Double plate fixation combined with autogenous iliac crest bone grafting results in successful salvage of humeral shaft nonunion after prior failed surgical interventions.

Download Full-text

Double Plating With Autogenous Bone Grafting as a Salvage Procedure for Recalcitrant Humeral Shaft Nonunion

10.21203/rs.3.rs-34226/v1 ◽

2020 ◽

Author(s):

Dongxu Feng ◽

Xiaolong Wang ◽

Liang Sun ◽

Xiao Cai ◽

Kun Zhang ◽

...

Keyword(s):

Bone Grafting ◽

Iliac Crest ◽

Humeral Shaft ◽

Autogenous Bone ◽

Radial Nerve Palsy ◽

Consecutive Series ◽

Salvage Procedure ◽

Iliac Crest Bone Grafting ◽

Humeral Shaft Nonunion ◽

The Mean

Abstract Background: Despite the majority humeral shaft nonunions respond well to surgical intervention, a surgeon still encounters a patient with humeral shaft nonunion who had already undergone repeated surgeries for nonunion. This study is a retrospective analysis of the efficacy of the treatment of recalcitrant humeral shaft nonunions using double locking compression plate (LCP) fixation in combination with autogenous iliac crest bone grafting.Methods: A consecutive series of aseptic recalcitrant humeral shaft nonunion underwent surgical treatment between May 2010 and August 2017 in the authors’ institute. Standardized treatment included a thorough debridement, double LCP and screw fixation, and autogenous iliac bone graft. The injury type, the bone affected by nonunion, and the duration of nonunion were recorded for all patients. The main outcome measurements were Constant and Murley scale for shoulder function, Mayo elbow performance index (MEPI) for elbow function and the visual analog scale (VAS) for pain. In addition, all complications were documented.Results: The study consisted of six females and nine males with a mean age of 45.3±13.1 years. Each patient had already undergone at least once failed surgical management for nonunion. The average duration that the bone remained ununited before the index intervention was 126.8±124.2 months. All patients achieved bone union without implant failure. At the final follow-up, both the mean Constant and Murley joint function score and the mean MEPI were significantly improved, and the mean VAS score significantly decreased. Each patient was highly satisfied with the treatment. Complications were only seen in four patents, including one super wound infection, one radial nerve palsy, one ulnar never palsy, and one discomfort at the iliac crest.Conclusion: Double plate fixation combined with autogenous iliac crest bone grafting can result in successful salvage of humerus nonunions in patients who have failed prior surgical interventions.

Download Full-text

Plate fixation with autogenous bone grafting for longstanding humeral shaft nonunion

Medicine ◽

10.1097/md.0000000000011974 ◽

2018 ◽

Vol 97 (35) ◽

pp. e11974 ◽

Cited By ~ 2

Author(s):

Dongxu Feng ◽

Jun Zhang ◽

Yangjun Zhu ◽

Shufang Wu ◽

Junping Shan ◽

...

Keyword(s):

Bone Grafting ◽

Plate Fixation ◽

Humeral Shaft ◽

Autogenous Bone ◽

Autogenous Bone Grafting ◽

Humeral Shaft Nonunion

Download Full-text

Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion

10.21203/rs.3.rs-34226/v2 ◽

2020 ◽

Author(s):

Dongxu Feng ◽

Xiaolong Wang ◽

Liang Sun ◽

Xiao Cai ◽

Kun Zhang ◽

...

Keyword(s):

Bone Grafting ◽

Iliac Crest ◽

Humeral Shaft ◽

Autogenous Bone ◽

Radial Nerve Palsy ◽

Consecutive Series ◽

Salvage Procedure ◽

Iliac Crest Bone Grafting ◽

Humeral Shaft Nonunion ◽

The Mean

Abstract Background: Despite the majority of humeral shaft nonunions respond well to surgical intervention, a surgeon still encounters a patient with humeral shaft nonunion who had already undergone repeated surgeries for nonunion. This study is a retrospective analysis of the efficacy of the treatment of recalcitrant humeral shaft nonunions using double locking compression plate (LCP) fixation in combination with autogenous iliac crest bone grafting.Methods: A consecutive series of aseptic recalcitrant humeral shaft nonunion underwent surgical treatment between May 2010 and August 2017 in the authors’ institute. Standardized treatment included a thorough debridement, double LCP and screw fixation, and autogenous iliac bone graft. The injury type, the bone affected by nonunion, and the duration of nonunion were recorded for all patients. The main outcome measurements were Constant and Murley scale for shoulder function, Mayo elbow performance index (MEPI) for elbow function, and the visual analog scale (VAS) for pain. In addition, all complications were documented.Results: The study consisted of six females and nine males with a mean age of 45.3±13.1 years. Each patient had already undergone at least once failed surgical management for nonunion. The average duration that the bone remained ununited before the index intervention was 126.8±124.2 months. All patients achieved bone union without implant failure. At the final follow-up, both the mean Constant and Murley joint function score and the mean MEPI were significantly improved, and the mean VAS score significantly decreased. Each patient was highly satisfied with the treatment. Complications were only seen in four patents, including one super wound infection, one radial nerve palsy, one ulnar never palsy, and one discomfort at the iliac crest.Conclusion: Double plate fixation combined with autogenous iliac crest bone grafting can result in successful salvage of humerus nonunions in patients who have failed prior surgical interventions.

Download Full-text