Locking compression plates and autologous bone graft for the humeral shaft nonunion after surgical failure

Abstract

Objective To evaluate the efficacy of secondary revision with locking compression plates (LCP) and autologous bone graft for nonunion of humeral shaft fracture after surgical failure. Methods Included in this study were 26 patients with nonunion of humeral shaft fracture after various surgical treatments who had received secondary revision with LCP and autologous iliac graft in our department between March 2006 and June 2008 and had been fully followed.They were 19 men and 7 women,with an average age of 46.7 years (range,19 to 63 years).There were 17 cases of hypertrophic nonunion,7 cases of atrophic nonunion and 2 cases of pseudarthrosis.The mean interval between the primary operative treatment and the secondary revision was 9.3 months (from 9.1 to 9.6 months). All nonunions were managed with removal of previous implants,open reduction and internal fixation with LCP,supplemented by cancellous bone graft.Functional recovery was evaluated by Mayo Elbow Performance Index and the modified scale of Constant and Murley. Results The average follow-up was 25.6 months (range,25 to 33 months).The secondary revision led to postoperative bone union in 25 patients after a mean time of 5.2 months (range,4 to 9 months).Only one patient suffered nonunion caused by wound infection before he eventually obtained bone union after anti-infective therapy for 5 months.Temporary palsy of the radial ncrve occurred in 2 cases.The mean functional scores for the shoulder (Constant) and the elbow (Mayo) were 79.1 ±0.1 and 85.7 ±0.8,respectively.Conclusions In revision of the nonunion of humeral shaft fracture after surgical failure,LCP and autologous bone graft can greatly increase the rate of union and reduce complications to ensure good functional recovery of the upper extremity.We believe the key to the procedure lies in complete resection of the nonunion ends and fibrous tissue,cortex-to-cortex apposition with stalwart compression across the entire site and wide use of autologous bone. Key words: Humeral fractures; Fractures, ununited; Fracture fixation, internal; Bone plates