TREATMENT OF HUMERAL SHAFT NONUNIONS WITH COMRESSION OF PSEUDARTHROTIC TISSUE WITHOUT BONE GRAFTING

Abstract

Humeral shaft fractures are among the most frequent fractures encountered in Orthopaedic Traumatology. Their treatment can be either conservative or operative depending on the location (proximal, middle or distal third), type (spiral, oblique, or transverse), radial nerve involvement, concomitant presence of thoracic injuries that preclude general anesthesia, as well as surgeon’s experience. Non union or delayed union complicates some of the conservatively and very few of the operatively treated fractures.

We report of our experience with the management of humeral shaft non unions in 28 patients treated at our institution from 1990 to 2000. Six were male and twelve female aging from 21 to 68 years (mean 45 years).The interval between initial injury and operation varied from 6 months to 3 years (average 10 months).Regarding the location of non union,20 cases were located in the middle, 6 cases in the upper and 2 cases in the distal third.

Operative technique: under general anesthesia using anterolateral approach for middle and distal third and deltopectoral approach for proximal third , the site of pseudarthrosis was exposed. In transverse and slightly oblique fractures a self compression plate was implanted without resection of pseudarthrosis or excessive soft tissue detachment .In spiral and true oblique fractures reduction performed initially, maintained with k-wires and fixated with self compression plate. Upon completion of osteosynthesis suction drain was put ,followed by wound closure and elastic bandage.

Postoperatively a colar cuff was used for 2 weeks .Follow up examination with radiographic evaluation was done after 3 and 6 months.

Signs of incomplete callus formation were obtained after 3 months whereas solid union was achieved after 6 months in all patients without any serious complication.