Humeral diaphyseal nonunions treated by interlocking or expandable intrameduilary nailing plus iliac bone grafting

Abstract

Objective To discuss the efficacy of interlocking or expandable intramedullary nailing plus iliac bone grafting for treatment of humeral diaphyseal nonunion.Methods From June 1999 to May 2008, 27 cases of humeral diaphyseal nonunion, 14 males and 13 females, were treated in our department.The nonunions occurred at the upper-middle humerus in 6 cases, at the middle humerus in 16 cases and at the middle-lower humerus in 5 Cases. The patients had previously undergone operations for 1 to 4 times (average,2.3 times). Interlocking nailing was applied in 16 cases (including one case of close nailing and 5 cases of cable tension band osteosynthesis after replacement of the original nailing); expandable nailing was applied in 11 cases. Autologous iliac bone grafting was performed in 26 cases except the one case of close nailing.Results Twenty-six cases were followed up for an average of 4 years and 2 months. Bony healing was obtained in 5.4 months on average. By Neer scoring, the shoulder functions were evaluated as excellent in 12,good in 8 and fair in 6 cases, with a good to excellent rate of 76. 9％. By Mayo clinic performance scoring,the elbow functions were excellent in 23 and good in 3 cases, with a good to excellent rate of 100％. One case of radial nerve palsy recovered 6 months after operation.ConclusionInterlocking or expandable intramedullary nailing plus iliac bone grafting is an effective method to treat nonunion of humeral diaphysis. Key words: Humeral fractures; Fractures, ununited; Bone nails; Fracture fixation, internal