Abstract
It has been reported that the majority of nonunions of the humeral shaft evaluated
are within the proximal one-third of the diaphysis. We are not aware of any reported
series of humeral nonunions dealing specifically with the proximal diaphysis. We therefore
sought to identify patients with a humeral shaft nonunion from an orthopaedic trauma
service database, determine the frequency of those within the proximal one-third and
review our treatment strategy and resulting clinical outcomes for these difficult
fractures. Clinical and radiographical follow-up was available for 19 patients with
a mean age of 70 years (range 29–94 years). This represented 46% of all humeral shaft
nonunions treated during the study period. Dual plating was used in 11 cases to get
adequate fixation in the proximal segment. Post-operative alignment was within 5°
of anatomic in all cases. All nonunions healed at an average of 15.2 weeks (range
8–36 weeks). The mean length of follow-up was 12.5 months (range 6–122 months). All
patients reported significant improvement in pain. The mean range of motion following
fracture union was forward flexion 137°, external rotation 41° and internal rotation
30°. There were two minor complications and neither required a secondary surgery.
The surgical technique we have used emphasising a thorough debridement of the nonunion
site, correction of the deformity, fracture site compression with a rigid construct
and bone grafting provides excellent rates of union and clinical outcomes.
Keywords
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Article info
Publication history
Accepted:
April 6,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
