Consistent Protocol-Based Management of Humerus Shaft Nonunion: An Analysis of 100 Cases

• Published in: Indian journal of orthopaedics 2023-04, Vol.57 (4), p.552-564
• Main Authors: Dheenadhayalan, Jayaramaraju, Vembanan, Kavinkumar, Devendra, Agraharam, Perumal, Ramesh, Nagashree, Vasudeva, Kumar, Aditya H., Rajasekaran, Shanmuganathan
• Format: Article
• Language: English
• Subjects: Conservative Orthopedics; Medicine; Medicine & Public Health; Original; Original Article; Orthopedics; Surgical Orthopedics
• ISSN: 0019-5413; 1998-3727
• DOI: 10.1007/s43465-023-00819-4

Introduction Humerus shaft nonunions are very disabling and challenging to treat. The current study aims to analyse the rate of union and the incidence of complications following a consistent protocol in treating humerus shaft nonunion. Methodology We did a retrospective analysis of 100 patients with humerus shaft nonunion treated over an eight-year period from 2014 to 2021. The mean age was 42 years (range 18–75 years). There were 53 male and 47 female patients. The average time interval from injury to nonunion surgery was 23 months (range 3 months to 23 years). The series included 12 recalcitrant nonunions and 12 patients with septic nonunion. All patients underwent freshening of fracture edges to increase the contact surface area, stable fixation with a locking plate and intramedullary iliac crest bone grafting. Infective nonunions were treated in a staged manner, following a similar treatment protocol after the elimination of infection in the first stage. Results Complete union was achieved in 97% of the patients with a single procedure. One patient achieved union after an additional procedure, while two patients were lost to further follow-up. The mean time to union was 5.7 months (range 3–10 months). Three patients (3%) had postoperative radial nerve palsy, which recovered completely within 6 months. Three patients (3%) had a superficial surgical site infection, while one patient (1%) developed a deep infection. Conclusion Intramedullary cancellous autologous grafts combined with stable fixation by compression plating achieve a high union rate with minimal complications. Level of Evidence III. Level of Clinical Care Level I Tertiary trauma centre.