Persistent non-union of the humeral shaft treated by plating and autologous bone grafting

Introduction Surgical treatment of persistent non-union of the humeral shaft is a complex situation because of the risk of failure and surgery-related complications. The primary objective of this study was to evaluate clinical and radiological results of a continuous series of persistent non-union t...

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Bibliographic Details
Published in:International orthopaedics 2017-02, Vol.41 (2), p.367-373
Main Authors: Pollon, Tristan, Reina, Nicolas, Delclaux, Stéphanie, Bonnevialle, Paul, Mansat, Pierre, Bonnevialle, Nicolas
Format: Article
Language:English
Subjects:
Aged
Bone Plates - adverse effects
Bone Transplantation - adverse effects
Bone Transplantation - methods
Female
Fibula - transplantation
Follow-Up Studies
Fracture Fixation, Internal - adverse effects
Fracture Fixation, Internal - methods
Fracture Healing
Fractures, Ununited - surgery
Human health and pathology
Humans
Humeral Fractures - surgery
Humerus - surgery
Ilium - transplantation
Life Sciences
Male
Medicine
Medicine & Public Health
Middle Aged
Original Paper
Orthopedics
Retrospective Studies
Transplantation, Autologous - adverse effects
Transplantation, Autologous - methods
Treatment Outcome
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Summary:Introduction Surgical treatment of persistent non-union of the humeral shaft is a complex situation because of the risk of failure and surgery-related complications. The primary objective of this study was to evaluate clinical and radiological results of a continuous series of persistent non-union treated with plating and bone grafting. The secondary objective was to expose factors contributing to the failure of prior bone union attempts. Material and Methods Sixteen patients (average age of 52 years) were treated for persistent non-union of the humeral shaft in our department; six of these patients had predisposing comorbidities or addictions. The persistent non-union was treated by plating with autologous bone graft from the iliac crest in a single-stage procedure in 12 cases and a two-stage procedure in three cases; one case was treated with plating and vascularized fibula graft. Results At a minimum follow-up of 12 months (average 78 months), four (25 %) failed to heal. The 12 other patients had bone union after an average of eight months. The average QuickDASH score was 48 points (18–72). A retrospective analysis of the prior attempts to treat the non-union revealed three cases of unstable fixation, four cases with no osteogenic supply and seven cases of positive microbiological cultures at the non-union site. Conclusion Plating and autologous bone grafting resulted in union in only 75 % of persistent non-union of the humeral shaft. The persistent nature of the humeral shaft non-union could be attributed to deviating from validated rules for surgical treatment and/or the presence of a surgical site infection.
ISSN:0341-2695
1432-5195
DOI:10.1007/s00264-016-3267-3