Research Article| Volume 41, ISSUE 12, P1262-1265, December 2010

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Isolated interfragmentary compression for nonunion of humeral shaft fractures initially treated by nailing: A preliminary report of seven cases



      Plating with bone grafting is considered the gold standard treatment for nonunion of humeral shaft fractures. However, this complex procedure involves multiple risks. The aim of this study is to evaluate an alternative treatment using isolated axial interfragmentary compression for the dynamisation of humeral shaft nonunion after retrograde locked nailing.

      Materials and methods

      Between January 2000 and May 2009, 124 humeral shaft fractures were treated in our trauma department with retrograde locked nailing using the unreamed humeral nail (UHN®, Synthes, Paoli, PA, USA). Nonunion occurred in seven patients (5.6%) – five females and two males, mean age 44 years (range: 17–73 years). The nonunion was treated by applying isolated secondary interfragmentary compression. Mean follow-up was 43 months (range: 8–74 months). The Rommens score and the disabilities of the arm, shoulder and hand (DASH) score were used to evaluate the global functioning of the upper limb.


      The compression procedure was successful in all seven cases. In each case, the union occurred without any complications in 3–5 months. The mean DASH score was 25/100 (range: 8.3–60.8/100). The Rommens score was judged excellent for five of the seven patients but two were rated moderate. One of these suffered from complex regional pain syndrome type II since the fracture, and another developed a stiff shoulder 6 months after trauma.


      Isolated secondary interfragmentary compression appears to be a simple and successful procedure in cases of humeral nonunion.


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        • Apard T.
        • Lahogue J.F.
        • Prové S.
        • et al.
        Traitement des fractures récentes de la diaphyse humérale par enclouage centromédullaire vérouillé rétrograde: une étude prospective de 58 cas.
        Rev Chir Orthop. 2006; 92: 19-26
        • Chantelot C.
        • Ferry S.
        • Lahoude-Chantelot S.
        • et al.
        Etude rétrospective des résultats du traitement chirurgical de 21 pseudarthroses de l’humérus.
        Chir Main. 2005; 24: 84-91
        • Dubert T.
        • Voche P.
        • Dumontier C.
        • Dinh A.
        Le questionnaire DASH.
        Chir Main. 2001; 20: 294-302
        • Garnavos C.
        • Mouzopoulos G.
        • Morakis E.
        Fixed intramedullary nailing and percutaneous autologous concentrated bone-marrow grafting can promote bone healing in humeral shaft fractures with delayed union.
        Injury. 2010; 41: 563-567
        • Gerber A.
        • Marti R.
        • Jupiter J.
        Surgical management of diaphyseal humeral nonunion after intramedullary nailing: wave-plate fixation and autologous bone grafting without nail removal.
        J Shoulder Elbow Surg. 2003; 12: 309-313
        • Ingman A.M.
        • Waters D.A.
        Locked intramedullary nailing of humeral shaft fractures.
        J Bone Joint Surg. 1994; 76B: 23-29
        • Lammens J.
        • Bauduin G.
        • Driesen R.
        • et al.
        Treatment of nonunion of the humerus using the Ilizarov external fixator.
        Clin Orthop Relat Res. 1998; 353: 223-230
        • McKee M.D.
        • Miranda M.A.
        • Riemer B.L.
        • et al.
        Management of humeral nonunion after the failure of locking intramedullary nails.
        J Orthop Trauma. 1996; 10: 492-499
        • Moulder E.
        • Sharma H.K.
        Tibial non-union: a review of current practice.
        Curr Orthop. 2008; 22: 434-441
        • Niéto H.
        • Aribit F.
        • Avedikian J.
        • et al.
        Les fractures de la diaphyse humérale. Table ronde de la Société Orthopédique de l’Ouest.
        Ann Orthop Ouest. 1997; 29: 129-159
        • Piétu G.
        • Raynaud G.
        • Letenneur J.
        Treatment of delayed and nonunions of the humeral shaft using the Seidel locking nail: a preliminary report of five cases.
        J Orthop Trauma. 1994; 8: 240-244
        • Rommens P.M.
        • Verbruggen J.
        • Broos P.L.
        Retrograde locked nailing of humeral shaft fractures. A review of 39 patients.
        J Bone Joint Surg. 1995; 77B: 84-89
        • Rommens P.M.
        • Blum J.
        • Runkel M.
        Retrograde nailing of humeral shaft fractures.
        Clin Orthop Relat Res. 1998; 350: 26-39
        • Rommens P.M.
        • Kuechle R.
        • Bord T.
        • et al.
        Humeral nailing revisited.
        Injury. 2008; 12: 1319-1328
        • Segonds J.M.
        • Alnot J.Y.
        • Masmejean E.
        Aseptic non-union of humeral shaft fractures treated by plating and bone grafting.
        Rev Chir Orthop Reparatrice Appar Mot. 2003; 89: 107-114
        • Sommer C.
        • Gautier E.
        • Muller M.
        • et al.
        First clinical results of the Locking Compression Plate (LCP).
        Injury. 2003; 34: B43-B54
        • Verbruggen J.P.
        • Stapert J.W.
        Failure of reamed nailing in humeral non-union: an analysis of 26 patients.
        Injury. 2005; 36: 430-438
        • Wang C.J.
        • Chen H.S.
        • Chen C.E.
        • Yang K.D.
        Treatment of nonunions of long bone fractures with shock waves.
        Clin Orthop Relat Res. 2001; 387: 95-101
        • Younger E.M.
        • Chapman M.W.
        Morbidity at bone graft donor sites.
        J Orthop Trauma. 1989; 3: 192-195