Open Reduction and Internal Fixation for Humeral Shaft Nonunion: Bone Grafting Is Not Routinely Required and Avoids Donor Site Morbidity

SummaryAutograft is considered ideal for grafting procedures, providing osteoinductive growth factors, osteogenic cells, and an osteoconductive scaffold. Limitations, however, exist regarding donor site morbidity and graft availability. Although allograft provides an osteoconductive matrix with some osteoinductivity, its availability is limited. To achieve optimal bone graft properties, researchers are developing new materials with the goal of designing synthetics as close to autograft as possible while still facilitating their clinical use. However, the constant evolution of internal fixation stimulates the search for growth factors and cells which could stimulate bone healing.

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Successful Treatment of a Persistent Humeral Shaft Nonunion Using Open Reduction Internal Fixation, Electrical Stimulation, and AlloMatrix Custom Bone Putty

Orthopedics ◽

10.3928/0147-7447-20040102-05 ◽

2004 ◽

Vol 27 (1) ◽

pp. 109-111 ◽

Cited By ~ 6

Author(s):

Michael Neel

Keyword(s):

Electrical Stimulation ◽

Internal Fixation ◽

Successful Treatment ◽

Open Reduction ◽

Open Reduction Internal Fixation ◽

Humeral Shaft ◽

Humeral Shaft Nonunion ◽

Bone Putty

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Combined Ipsilateral Humeral Shaft and Galeazzi Fractures Creating a Floating Elbow Variant

Case Reports in Orthopedics ◽

10.1155/2018/7430297 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Patrick Lee ◽

Allison Z. Piatek ◽

Michael J. DeRogatis ◽

Paul S. Issack

Keyword(s):

Internal Fixation ◽

Range Of Motion ◽

Open Reduction ◽

Humeral Fracture ◽

Humeral Shaft ◽

Proximal Ulna ◽

Elbow Injury ◽

Anatomic Reduction ◽

Elbow Injuries ◽

Floating Elbow

“Floating elbow” injuries of the arm traditionally represent a combination of humeral shaft and forearm fractures which require anatomic rigid open reduction and internal fixation of all fractures to allow for early range of motion exercises of the elbow. There are published variants of the floating elbow injury which include ipsilateral diaphyseal humeral fracture, proximal ulna fracture with proximal radioulnar joint disruption, and ipsilateral diaphyseal humeral fracture with elbow dislocation and both bones forearm fracture. We present the case of a 21-year-old woman whose left arm became caught between the side of a waterslide and adjacent rocks at a park. She sustained a torsional and axial loading injury to her left upper extremity resulting in ipsilateral humeral shaft and Galeazzi fractures. The combination of ipsilateral humeral shaft and Galeazzi fractures resulted in a rare floating elbow variant. Prompt open reduction and internal fixation of both fractures and early range of motion of the elbow and wrist resulted in an excellent clinical and radiographic result. Floating elbow injuries and their variants should be promptly recognized as early anatomic reduction, and rigid internal fixation can allow for good elbow function with minimization of stiffness.

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OPINION: Open Reduction and Internal Fixation and Resection Tricortical Bone Grafting

Journal of Orthopaedic Trauma ◽

10.1097/00005131-200408000-00015 ◽

2004 ◽

Vol 18 (7) ◽

pp. 471-472

Author(s):

Joseph Borrelli

Keyword(s):

Internal Fixation ◽

Bone Grafting ◽

Open Reduction

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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.

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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.

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