Nonunion Of Humeral Shaft Fracture Research Articles

Evaluation of Three Bridging Tricorticocancellous Bone Grafts in the Treatment of Old Non-uniting Fractured Humerus

Background: Nonunion of humeral shaft fracture after conservative treatments or frequent failed surgical treatment of bone healing exemplify the difficulties in managing a bone defect or severely damaged individuals. Aim of the study: The present study was undertaken to evaluate three bridging tricoticocancellous bone grafts in the treatment of old non-uniting fractured humerus. Materials and Methods: From June 2014 to December 2019, three bridging tricoticocancellous bone grafts were used to treat non-union humeral shaft fractures using dynamic compression plates at Sulaimani Teaching Hospital in Iraq. Results: Sixteen patients, 11 males, and 5 females, varying in age from 28 to 64 years old (mean age 41) were recruited for the study. Six patients had previously undergone conservative treatment, and ten patients had previously undergone surgical treatment, such as open reduction and internal fixation with plates and screws or various intramedullary nails. Four out of ten patients had previously received bone transplants in conjunction with internal fixation. The nonunion lasted between 2 and 4 years (a mean of 3 years). In patients who were treated by recanalization of the medullary canal healing rate of a non-uniting fractured shaft, humerus reached 100% in all 16 patients, indicating improvements in both bone healing and functional index outcomes. The satisfaction rate score was in 15 patients (93.75%). Also, the function score was excellent in 15 patients (93.75%), while the movement score was in 14 patients (87.5%). The union rate, angular deformity, and limb shortening were used to evaluate bone results. Conclusion: When using the technique of medullary recanalization opening the bone canal, and fixation by dynamic compression plate for old non-uniting fractured shaft humerus patients, the findings confirm that three bridging tricoticocancellous bone grafts are superior in healing and union, improved arm function, and a high satisfaction rate as achieved.

Predicting the Behavior of Humeral Shaft Fractures: An Independent Validation Study of the Radiographic Union Score for HUmeral Fractures and Value of Assessing Fracture Mobility.

To externally validate the Radiographic Union Score for HUmeral fractures (RUSHU) and to quantify the predictive relationship of fracture motion on physical examination to nonunion. Retrospective cohort study. Single institutional center (University teaching hospital). Ninety-two consecutive patients undergoing nonoperative treatment of a diaphyseal humeral shaft fracture were identified over a 4-year period. The average age of the population was 62 years and 42% of the cohort was men. Clinical examination for fracture stability was routinely performed on patients by the treating physicians. Radiographic assessment of fracture callus (RUSHU score) at 6 weeks was retrospectively determined. Patients were followed up until union. Stability was graded as motion at the fracture site or the humerus moving as a single functional unit. Fractures with a RUSHU score ≤7 were 14 times more likely to proceed to nonunion at 6 months (78% sensitivity, 80% specificity). The time to union was 49 weeks for a RUSHU score of ≤7 versus 16 weeks for a RUSHU score of ≥8. The number of operations needed to avoid one nonunion was 1.7. Fractures mobile at 6 weeks were 6.5 times more likely to proceed to nonunion at 6 months (77% specificity, 67% sensitivity). Mobile fractures had a longer time to union (41 weeks) than nonmobile fractures (17 weeks). The RUSHU score and clinical assessment of fracture mobility are effective and valid tools in identifying patients at risk of developing nonunion of humeral shaft fractures and can enhance early decision making in fracture management. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Results of Surgical treatment of Nonunion of Humeral Shaft Fracture with Dynamic Compression Plate and Cancellous Bone Grafting

Results of Surgical treatment of Nonunion of Humeral Shaft Fracture with Dynamic Compression Plate and Cancellous Bone Grafting

Nonunion of humeral shaft fractures following flexible intramedullary nail fixation

Introduction: The treatment of humeral shaft fractures ranges from conservative modalities to operative fixation, including plate osteosynthesis and intramedullary fixation. Nonunion is a complication of conservative and operative interventions but is more often associated with elastic nailing. This article discusses the successful outcomes for treatment of nonunion of humeral shaft fracture achieved by Locking Compression Plate (LCP) with autogenous bone grafting. Methods: Fifteen cases of nonunion of humeral shaft fracture primarily treated with Elastic nail were included in this study. The study population comprised 12 males and 3 females with an average age of 31.2 years with minimum follow up of 12 months. Eleven fractures were defined as atrophic nonunion, and 4 as hypertrophic. All fractures were managed by open reduction and internal fixation with LCP and autogenous cancellous bone graft with mean follow-up period of 14 months.Results: All cases showed union at subsequent follow-up with an average of 14 weeks (range 12-16 weeks). Complications included one patient with radial nerve neuropraxia which recovered spontaneously within 3 months of surgery, and a patient with superficial wound infection which was managed by debridement and antibiotics. At the final follow-up, shoulder and elbow functions of the operated limbs were satisfactory (4 Excellent, 11 Good results with an average ASES score of 46). Conclusion: Fixation by LCP with cancellous bone graft is reliable and effective treatment for nonunion of humeral shaft fracture. The combined use of LCP and autogenous cancellous bone graft is able to achieve both rigid fixation and improve osteogenesis.

Evaluation of the results of locking compression plate for the treatment of non-united humeral shaft fracture augmented with autogenous cancellous bone graft

A fracture bone usually heals by the formation of new bone at the fracture site. Occasionally, only fibrous tissue is formed, when this happens both surgeon & patient are disappointed. The bone is a specialized form of connective tissue may account for its ability to heal by the formation of new bone. The humerus is a long bone connecting two important joints of upper limb- which has wide range of movement having very little bony stability in shoulder joint and distal elbow joint which is a uni axial hinge joint. This prospective study of "treatment of nonunion of humeral shaft fracture by locking plate and screws augmented with autogenous cancellous bone grafting" was carried out during the period of 1st December 2011 to 31th May 2013 at National Institute of Traumatology and Orthopeadic Rehabilitation (NITOR) Dhaka, Bangladesh. Sample size will be calculated by using following statistics = 384. Purposive sampling (non-randomized) according to availability of the patients and strictly considering the inclusion and exclusion criteria. Data will be collected with a pre-tested structured questionnaire containing history, clinical examination, laboratory investigations, pre-operative, per-operative, postoperative follow up findings and complications. 16 Patients were selected by using non randomized sampling method. The age ranges from 28-60 years. The mean age of occurrence was 38.19 (+10.04) years. Motor vehicle accident was the commonest cause of fracture found in 81.25% cases. Second most common cause was fall from height (12.50%). Right side involvement was more (62.50%). Among the affected people serTce holders and shopkeepers were commonest (25% each), next were businessmen and farmers (18.75% each). The mean union time was 16.38 (+2.78) weeks. Postoperative complications were noticed such as wound infection (6.25%) and shoulder pain (6.25%). There was no complication (81.25%). Functional outcome of this treatment was analyzed by Constant and Murley scoring (1999). Excellent functional outcome was found in 5 (31.25%) cases, good in 9 (56.25%) cases, fair in 1 (6.25%) case and poor in 1 (6.25%) case. Regarding the final outcome satisfactory result was found in 14 (87.50%) cases and unsatisfactory result in 2 (12.50%) cases. Based on the results shown above it is concluded that "treatment of nonunion of humeral shaft fracture by locking plate and screws augmented with autogenous cancellous bone grafting" is an effective modality of treatment for the nonunion of humeral shaft fracture and is especially recommended in osteoporotic bones and elderly patients with compromised bone quality.

Comparative study of bridging Tricoticocancellous bone graft post medullary canal recanalization versus classical bone graft without opening medullary canal both procedures were used dynamic compression plate fixation in treatment of non-uniting fracture shaft humerus

Background: Nonunion of a Humerus shaft fracture after conservative treatments or repeatedly failed surgical attempts bone healing a difficult therapeutic problem especially in the presence of osteoporosis, bone defect, and joint stiffness. We evaluated the treatment of nonunion of humeral shaft fracture with dynamic compression plate from June 2004 to December 2009 in Sulaimani Teaching Hospital, for healing of Nonunion fracture humerus. Aim of study: The lack of mechanical stability due to a flail arm functionally affected that interference with personal hygiene, dressing, and daily activities. The goal of surgery is to achieve a stable rigid fixation on healed nonunion fracture humerus, plus early mobilization. Methods: We evaluated the treatment of nonunion of humeral shaft fracture with dynamic compression plate from June 2004 to December 2009 in Sulaimani Teaching Hospital, for healing of nonunion humerus .44 patients randomly collected, classified into two groups. Group A, 22 patients were treated by recanalization opening the medullary canal with bridging Tricoticocancellous bone graft. Group B 22 patients were treated by bone graft alone without opening the medullary canal. Both groups were using compression plate Fixation in treatment of Non-uniting fracture shaft humerus. Results: In group a, 22 patients age range 22-60 years (mean age 41years). There were 16 males and 6 females. Four patients had open fractures; (one due to explosion of a truck tire, second due to machine injury, and two dues to road traffic accidents). 8 patients had treated conservatively, 14 patients had previous surgical treatment in the form of open reduction and internal fixation using plates and screws, intramedullary nails of different types. 12 patients autogenous ICBG were used previously at least once time together with internal fixation. The mean duration of nonunion was 4 years between 2- 6 years. Group B, the mean age between 25-64 years (mean age 44.5 years). There were 18 males and 4 females' patients. Two patients had open fractures. 10 patients had treated conservatively, 12 patients had previous surgical treatment in the form of open reduction and internal fixation using plates and screws, intramedullary nails of different types. 10 patients autogenous ICBG were used previously at least once time together with internal fixation. The mean duration of nonunion was 4.5 year between 3- 6 years. We detected improvements in our study for both bone healing index results and functional index outcome. The bone results were evaluated by the union rate, angular deformity, and limb shortening. The functional outcomes were evaluated for pain, function, movement, muscle power, and patients satisfaction. Conclusion: We confirm that recanalization opening medullary canal plus three Tricoticocancellous bone graft are superior in healing of Non-uniting fracture humerus than without recanalization non-opening medullary canal. However, we used dynamic compression plating in both techniques.

Outcomes and Complications of Nonunion of Humeral Shaft Fractures Treated with Locked Compression Plate: A Prospective Study

Outcomes and Complications of Nonunion of Humeral Shaft Fractures Treated with Locked Compression Plate: A Prospective Study

Plating, Nailing, External Fixation, and Fibular Strut Grafting for Non-Union of Humeral Shaft Fractures

To compare various treatment modalities (plating, Ilizarov external fixation, and non-vascular fibular cortical strut grafting) for non-union of humeral shaft fractures. Records of 9 women and 26 men aged 24 to 71 (mean, 42) years who presented with non-union of humeral shaft fractures were reviewed. The humeral shaft fractures were secondary to low-energy trauma (n=22) or vehicular accidents (n=13) and involved the proximal (n=9), middle (n=15), and distal (n=11) regions. 13 of the fractures were open. Infection was evident in 8 of the non-unions. For non-unions with infection (n=8), a 2-stage procedure entailing temporary Ilizarov fixation followed by plating was used. For non-unions without infection (n=23), one-stage plating and cancellous bone grafting was used. For non-unions of osteoporotic bone (n=4), one-stage non-vascularised fibular strut grafting was used. Outcome was measured using the Disabilities of the Arm, Shoulder and Hand (DASH) scoring system. The 35 patients were followed up for a mean of 16 (range, 6-60) months. All achieved bone union except for one (who had persistent infection). Respectively for non-unions with infection, nonunions without infection, and non-unions of osteoporotic bone, the mean times to bone union were 6.5 (range, 4-10), 5 (range, 4-8), and 10 (range, 6-14) months, the mean improvement in DASH score was 30, 43, and 18, and malalignment was noted in 5, 2, and one patient. Three patients had a preoperative radial nerve palsy for which standard tendon transfer was performed 6 weeks after treatment for non-union. Compression plating achieved the best results. An external fixator may be used temporarily for infected non-unions. Fibular strut grafting may be used when non-unions warrant additional stability.

Outcome of locking compression plates in humeral shaft nonunions

Background: Nonunion of diaphyseal fractures of the humerus are frequently seen in clinical practice (incidence of up to 15% in certain studies) and osteosynthesis using dynamic compression plates, intra medullary nails and Ilizarov fixators have been reported previously. Locking compression plates (LCP) are useful in the presence of disuse osteoporosis, segmental bone loss and cortical defects that preclude strong fixation. We report a prospective followup study of the outcome of the use of LCP for humeral nonunion following failed internal fixation in which implants other than LCP had been used. Materials and Methods: Twenty four patients with nonunion of humeral shaft fractures following failed internal fixation were included in the study. The mean followup period was 3.4 years (range: 2.4 to 5.7 years) and the minimum followup period was 2 years. Mean age of the patients was 41.04 years (range: 24 to 57 years). All 24 patients underwent osteosynthesis using LCP and autologous bone grafting (cortico‑cancellous iliac crest graft combined with or without fibular strut graft). Main outcome measurements included radiographic assessment of fracture union and pre and postoperative functional evaluation using the modified Constant and Murley scoring system. Results: 23 out of 24 fractures united following osteosynthesis. Average time to union was 16 weeks (range: 10 to 28 weeks). Complications included delayed union (n = 2), transient radial nerve palsy (n = 2) and persistent nonunion (n = 1). Functional evaluation using the Constant and Murley score showed excellent results in 11, good in 10, fair in two and poor outcome in one patient. Conclusions: Locking compression plating and cancellous bone grafting is a reliable option for achieving union in humeral diaphyseal nonunion with failed previous internal fixation and results in good functional outcome in patients with higher physiological demands.

Outcome of locking compression plates in humeral shaft nonunions

Background:Nonunion of diaphyseal fractures of the humerus are frequently seen in clinical practice (incidence of up to 15% in certain studies) and osteosynthesis using dynamic compression plates, intra medullary nails and Ilizarov fixators have been reported previously. Locking compression plates (LCP) are useful in the presence of disuse osteoporosis, segmental bone loss and cortical defects that preclude strong fixation. We report a prospective followup study of the outcome of the use of LCP for humeral nonunion following failed internal fixation in which implants other than LCP had been used.Materials and Methods:Twenty four patients with nonunion of humeral shaft fractures following failed internal fixation were included in the study. The mean followup period was 3.4 years (range: 2.4 to 5.7 years) and the minimum followup period was 2 years. Mean age of the patients was 41.04 years (range: 24 to 57 years). All 24 patients underwent osteosynthesis using LCP and autologous bone grafting (cortico-cancellous iliac crest graft combined with or without fibular strut graft). Main outcome measurements included radiographic assessment of fracture union and pre and postoperative functional evaluation using the modified Constant and Murley scoring system.Results:23 out of 24 fractures united following osteosynthesis. Average time to union was 16 weeks (range: 10 to 28 weeks). Complications included delayed union (n = 2), transient radial nerve palsy (n = 2) and persistent nonunion (n = 1). Functional evaluation using the Constant and Murley score showed excellent results in 11, good in 10, fair in two and poor outcome in one patient.Conclusions:Locking compression plating and cancellous bone grafting is a reliable option for achieving union in humeral diaphyseal nonunion with failed previous internal fixation and results in good functional outcome in patients with higher physiological demands.

Pseudarthrose aseptique de la diaphyse humérale traitée par plaque vissée et autogreffe osseuse (à propos de 20 cas)

Although aseptic non-union of humeral shaft fractures is generally considered to be an exceptional complication, rates in the literature have varied from 1 to 10%. The aim of this retrospective study was to study the results of treatment by plating and bone grafting for aseptic non-union of humeral shaft fractures. The retrospective study gathered 20 patients, the mean age was 41 years. The most common fracture site was the middle third. For the follow-up evaluation, we used the Steward and Hundley score. According to this score, we noted: 13 very good results, five good results and two poor results. Management of non-union of the humerus should be optimal at immediate surgery. The best treatment of non-union of the humerus is its prevention by correct management of the initial fracture.

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

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

Nonunited humerus shaft fractures treated by external fixator augmented by intramedullary rod

Background:Nonunion of humeral shaft fractures after previously failed surgical treatment presents a challenging therapeutic problem especially in the presence of osteoporosis, bone defect, and joint stiffness. It would be beneficial to combine the use of external fixation technique and intramedullary rod in the treatment of such cases. The present study evaluates the results of using external fixator augmented by intramedullary rod and autogenous iliac crest bone grafting (ICBG) for the treatment of humerus shaft nonunion following previously failed surgical treatment.Materials and Methods:Eighteen patients with atrophic nonunion of the humeral shaft following previous implant surgery with no active infection were included in the present study. The procedure included exploration of the nonunion, insertion of intramedullary rod (IM rod), autogenous ICBG and application of external fixator for compression. Ilizarov fixator was used in eight cases and monolateral fixator in ten cases. The monolateral fixator was preferred for females and obese patients to avoid abutment against the breast or chest wall following the use of Ilizarov fixator. The fixator was removed after clinical and radiological healing of the nonunion, but the IM rod was left indefinitely. The evaluation of results included both bone results (union rate, angular deformity and limb shortening) and functional outcome using the University of California, Los Angeles (UCLA) rating scale.Results:The mean follow-up was 35 months (range 24 to 52 months). Bone union was obtained in all cases. The functional outcome was satisfactory in 15 cases (83%) and unsatisfactory in 3 cases (17%) due to joint stiffness. The time to bone healing averaged 4.2 months (range 3 to 7 months). The external fixator time averaged 4.5 months (range 3.2 to 8 months). Superficial pin tract infection occurred in 39% (28/72) of the pins. No cases of nerve palsy, refracture, or deep infection were encountered.Conclusion:The proposed technique is effective in treating humeral nonunion especially in the presence of osteoporosis and short bone segments. The inclusion of intramedullary rod as internal splint improves stability of fixation and prevents refracture after fixator removal.

Resultados de tratamento cirúrgico da pseudoartrose de fratura diafisária do úmero com placa de compressão dinâmica e enxerto de osso esponjoso

ObjectiveWe evaluated the treatment of nonunion of humeral shaft fracture with dynamic compression plate from January 2002 to December 2009.MethodsTwenty-two patients were treated over the study period. Trauma was the predominant cause of injury in 86.4% of the patients.ResultsNonunion was atrophic in 81.8% and hypertrophic in 18.2% of the individuals. There was a primary injury of the radial nerve in 27.3% of the patients. All the participants had closed fracture at presentation, and 81.2% had received previous treatment from traditional bone setters and 18.8% had failure of the conservative cast management. The average time to healing was 16 weeks. Previous treatment from traditional bone setters significantly affected the time to fracture healing (p<0.05). All fractures had successful union.ConclusionIt was concluded that dynamic compression plating remains an effective treatment option for nonunion of humeral shaft fracture. Level of Evidence III, Retrospective study.

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

IntroductionPlating 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 methodsBetween 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. ResultsThe 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. ConclusionIsolated secondary interfragmentary compression appears to be a simple and successful procedure in cases of humeral nonunion.

Revision With Dynamic Compression Plate and Cancellous Bone Graft for Aseptic Nonunion After Surgical Treatment of Humeral Shaft Fracture

We evaluated the effect of revision with dynamic compression plate (DCP) and cancellous bone graft for aseptic nonunion after surgical treatments of humeral shaft fracture. Eighty-six patients with aseptic nonunion of humeral shaft fracture after various surgical treatments were reviewed and analyzed retrospectively between January 1982 and August 2006. There were 59 men and 27 women with the average age of 42 years (range, 19-81 years). Thirty-one fractures were defined as atrophic nonunion, 45 fractures were hypertrophic nonunion, and 10 fractures could not be defined clearly. All the fractures were managed with removal of previous implants, open reduction and internal fixation with DCP, supplemented by cancellous bone graft. The follow-up period was 38 months in average (range, 12-288 months). Functional evaluations were done by Mayo Elbow Performance Index and the modified scale of Constant and Murley. All the nonunions united with the average union time of 18 weeks (range, 14-26 weeks). Complications included five temporary radial nerve palsies and two wound infections. In final follow-up, the shoulder and elbow functions of the operated limbs were all noted to be good or excellent. DCP with cancellous bone graft is a reliable and an effective treatment for revision of aseptic nonunion of humeral shaft fracture after surgical treatment.

Accessory radial collateral vascular bone graft for the management of nonunion of humeral shaft fracture after intramedullary nailing

An easy pedicle vascular bone graft technique for the management of nonunion of humeral shaft fracture is described. The distal and lateral part of the humerus, including the lateral epicondyle, is transferred to the nonunion site of the humerus. This vascular bone graft is based on the accessory radial collateral artery. It promotes healing of the nonunion.

Treatment of nonunion of humeral shaft fracture with plate fixation and bone graft

目的 评价钢板内固定结合自体松质骨植骨治疗肱骨干骨折术后骨不愈合的疗效.方法2002年2月～2004年12月对41例肱骨干骨折术后骨不愈合患者均采用钢板内固定结合自体松质骨植骨治疗.其中男32例,女9例;平均年龄37.5岁(17～67岁).骨不愈合类型:肥大型16例,萎缩型25例.结果所有患者获平均22.6个月(8～42个月)随访.40例(97.6%)患者骨折愈合,骨折愈合时间平均为5.8个月(3～12个月).并发症:桡神经损伤3例,伤口感染1例,骨折不愈合1例.最终随访时,肩关节和肘关节功能恢复满意.结论对于肱骨干骨折术后骨不愈合的患者,采用钢板内固定加自体松质骨植骨治疗是有效的方法。

Treatment of Nonunion of Humeral Shaft Fracture with Dynamic Compression Plate and Cancellous Bone Graft

This study was conducted to evaluate the treatment of aseptic nonunion of the humeral shaft with a dynamic compression plate (DCP) and cancellous bone graft. One hundred and five cases of nonunion of a humeral shaft fracture between 1982 and 2001 were analyzed retrospectively. The study population comprised 66 males and 39 females with an average age of 46.2 years (range, 17-81 years). Sixty-seven fractures were defined as atrophic nonunion, and 20 as hypertrophic nonunion, whereas 18 could not be defined clearly. All the fractures were managed by open reduction and internal fixation with DCP and cancellous bone graft. The mean follow-up period was 20 months (range, 14-28 months). All nonunion fractures united within an average of 16 weeks (range, 10-26 weeks). Complications included 4 patients with temporary radial-nerve palsies, and 3 patients with wound infections. At the final follow-up, shoulder and elbow functions of the operated limbs were all satisfactory. Fixation by DCP with supplemental cancellous bone graft is a reliable and effective treatment for nonunion of a humeral shaft fracture.

Nonsteroidal antiinflammatory drugs and nonunion of humeral shaft fractures

To analyze the relationship between nonunion of humeral shaft fractures and nonsteroidal antiinflammatory drug (NSAID) exposure in older adults. A cohort of 9,995 patients with humeral shaft fractures was identified using diagnosis and procedure codes from a Medicare database of >500,000 patients. Prescription NSAID as well as prescription opioid use was assessed from pharmacy claims data for 3 30-day periods immediately after the initial fracture. Nonunion was defined by the presence of procedure codes for repair of nonunion 90-365 days after the index fracture. We examined the association between NSAIDs and nonunion using multivariate Cox proportional hazards models. Of the 9,995 humeral shaft fractures, 105 patients developed nonunions (1.1%), and 1,032 (10.3%) were exposed to NSAIDs in the 90 days after fracture. NSAID exposure within the first 90 days was significantly associated with nonunion (relative risk [RR] 3.7, 95% confidence interval [95% CI] 2.4-5.6). When indicators for exposure to NSAIDs during each of the 3 30-day windows were placed into the same multivariate model, only the period 61-90 days post-fracture was significantly associated with nonunion (RR 3.9, 95% CI 2.0-6.2). We observed a similar association between opioids and nonunion, with exposure to opioids between 61 and 90 days associated with nonunion (RR 2.7, 95% CI 1.5-5.2), but exposure to opioids during neither of the 2 earlier 30-day periods significantly associated with nonunion. We found that exposure to nonselective NSAIDs or opioids in the period 61-90 days after a humeral shaft fracture was associated with nonunion. Although these associations may be causal, they are more likely to reflect the use of analgesics by patients with painful nonhealing fractures.