Publication:

Reconstruction of aseptic humerus non-union with compression plating and cortico-cancellous bone grafting

Background Managing humeral shaft nonunion requires a comprehensive approach. Key factors include infection, prior surgeries, and severe bone loss. Treatment is challenging due to various surgical options, a lack of clear protocols, and limited evidence-based guidelines.

Methods Forty-four adults with humeral shaft nonunion (not caused by infection) were treated over 8 years from January 2012 to December 2020. Seven cases were particularly stubborn. Cases were excluded if they involved open fractures, infections, breaks with big gaps, bone disease, or other upper limb injuries. Treatment included removing unhealthy bone and tissue, correcting bone shape, using the patient’s own bone to help healing, and fixing the bone with a strong plate. Outcomes were assessed using the DASH (Disabilities of the Arm, Shoulder, and Hand) score at baseline and at least 24 months later.

Results Patients were followed for an average of 75 months. All patients healed. On average, healing took about 6 months (ranging from 4 to 12 months). Four patients (11.1%) had temporary nerve problems that fully recovered within 6 months. Two patients (5.5%) had mild wound infections. Arm function scores improved from an average of 76 before treatment to 7 at the end, showing excellent recovery.

Conclusions Our study shows that open surgery with a locking plate, supplemented with additional bone when needed, is very effective for healing stubborn humeral shaft fractures. Careful steps, such as gentle tissue handling, maintaining a healthy blood supply, and fully removing the bad tissue, are key to success.