275 Validation of The Radiographic Union Score for Humeral Fractures (RUSHU) For Prediction of Humeral Shaft Nonunion

Aim To validate the use of RUSHu score in prediction of humerus non union. Method All patients having radiographs of humerus performed between Jan 2016 to December 2018 were assessed based on inclusion and exclusion criteria. The RUSHu scoring system as published was used to score each 6-week radiograph, separately by 2 blinded observers. 6 months was used as end point to assess outcome. Cohort of 188 observations were used to assess utility of scoring system to predict non union. Results 94 suitable fractures were identified. Union rate of 72.3% was observed. Mean score in union group was 9.6, 6.4 for non-unions. There was substantial inter-observer reliability with an ICC of 0.73. Rate of union progressively increases with increasing RUSHu scores. ROC curve analysis identifies 8 as most suitable for use as threshold. Area under the curve is high (0.9) Conclusions A low RUSH score at 6 weeks is a reliable predictor of non union down the line. If a score 7 or lower is observed, it should trigger a discussion with the patient and review of correctable factors contributing to development of non union. Consideration of surgical fixation should be made at this stage if instability is felt to be a major contributing cause. A patient with score of 8 or higher is more likely to go on to union. Routine use of RUSHu score can aid in clinical decision making and introduce an element of objectivity in clinical assessment. It has potential to prompt earlier intervention and reduce morbidity duration.

Closed Compression Nailing Using a New-Generation Intramedullary Nail without Autologous Bone Grafting for Humeral Shaft Nonunion

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.

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

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.

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

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.

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

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.