Internal Fixation And Bone Grafting Of Non-Union Humeral Diaphyseal Fracture

Abstract

Background: Humeral diaphyseal fracture usually
heals with closed methods but when nonunion
develops then it needs surgical intervention in the
form of plating and bone grafting, intramedulary
nailing (open or closed simple or interlocking nails)
and external fixators (circular or one plane fixator).
In our unit we treated non union humeral
diaphyseal fracture with plating and bone grafting
shortening of fracture ends up to 4 to 5cm when
needed. Methods: This study was conducted at
Orthopaedic Department of AL-Sadar General
Hospital from January 2004 till December2005 .
We included 20 cases with atrophic non-union in
12(60%) and hypertrophic non-union in 8 (40%)
patients. All atrophic non-union were treated with
plating, bone shortening by transverse osteotomy
and bone grafting, while hypertrophic non-union
were treated with decortications of non-union ends
and fixation with compression plates, with bone
grafting in old age. Follow up measures were based
on clinical (range of joints motion) and radiological
(healing) findings. Follow up was done for upto 6
months . Results: Out of 20 patients the age range
was 20- 60 years, 16 (80%)were male and 4(20%)
female. Right humerus involved in 15( 75 %)
while left humerus in 5( 25%) patients.
In12(60%) patients with atrophic non union bone
shortening by transverse cut osteotomy was done
while in remaining patients with hypertrophic nonunion
plating was done in 2( 10 %) cases and
plating with bone grafting in 6( 30%) patients.
Union was achieved in all patients after 16 to 20
weeks of surgery. In one patient ( 5 %) of 75 years
age with hypertrophic non-union implant was
loosened after 3 months of surgery. At that time
healing (Union) was evident on X-rays and humeral
brace was applied for further 3 months. Two
patients( 10 %) got neuropraxia of radial nerve
which resolved with in 3 months time. 2 patients
(10 %) developed shoulder stiffness which resolved
after exercise. Conclusion: In Non Union of
Humerus shortening by transverse osteotomy &
rigid fixation with plates give excellent results in
selected cases.