Treatment of Osteopenic or Non-united Fractures of the Humerus with Structure Bone Allograft and Non-locking Plates

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Background: Treatment of osteopenic or non-united fractures of the humerus are difficult to achieve optimum mechanical stabilization before bone union. This report presents the clinical experience of structure bone allograft augmentation plus non-locking plates fixation for these complex fractures. Patients and methods: Twenty-four patients with osteopenic or non-united fractures of the humerus (thirteen proximal humerus and eleven humeral shaft fractures) were selected and treated with structure bone allograft augmentation and non-locking internal fixation. All patients were followed and evaluated using shoulder-joint range of motion, the American Shoulder and Elbow Surgeons (ASES) scale and radiographic examination for fracture union assessment. Results: The mean duration of follow-up was 45.3 months. The average time from surgery to the date of radiographic union was 3.6 months (range, 2.5-4.5 months). Twenty-three patients showed radiographically bony union. The total union rate was 95.8%. The average injured shoulder forward flexion was 120 degrees, the external rotation averaged 42 degrees and the internal rotation averaged to the 12th thoracic vertebra. The ASES score improved from an average of 37 preoperatively to 85 postoperatively. One patient had the complication of persistent non-union and loss of reduction. Conclusions: Structure bone allograft can be used as a strong adjuvant mechanical support for internal fixation for the weakened osteopenic humeral fractures. Through rigid fixation and good stabilization, this method can provide an effective treatment for the management of severely osteopenic or non-united fractures of the humerus.