Uninfected nonunion of the humeral diaphyses: Review of 21 patients treated with shingling, compression plate, and autologous bone graft

SummaryIntroductionControversy continues around selecting the best strategy for managing nonunions of the humeral diaphysis. The objective of this retrospective study was to analyse the results of management of this complication using a uniform surgical technique.HypothesisThe rate of union obtained in the present series is comparable to the results reported in the literature.Patients and methodsTwenty-one patients were surgically treated at the Geneva University Hospital for nonunion of the humeral diaphysis between 1995 and 2005 with a mean follow-up of 50 months. Open reduction and internal fixation in compression using plates and screws with autologous bone graft enhancement was used. Eight cases were revisions of nonunions following a closed orthopaedic treatment and 13 cases were revisions following a failed surgical treatment.ResultsAll the patients obtained union within a mean 4.5 months. The functional scores for the shoulder (Constant) and the elbow (Mayo) were 77 and 97 points (mean), respectively. Two patients developed transient paresis related to radial nerve and musculocutaneous nerve injuries and one had a recurring fracture. A single patient required a second intervention for delayed union.DiscussionOf the surgical techniques for managing nonunion of the humerus, plate osteosynthesis is the most widely used. This simultaneously allows anatomic reduction, fracture compression, and osteogenesis stimulation. However, it can lead to infectious complications (although absent in our series) and neurological complications (10% transitory paresis in our patients). We report 95% rapid union in our series. Other techniques such as intramedullary nailing and external fixation do not provide equivalent results, and this is in agreement with the data found in the literature. We therefore recommend using compression plate fixation associated with autologous bone graft for the treatment of established nonunion of the humeral shaft.Level of evidenceLevel IV. Retrospective study.