MANAGEMENT OF HUMERAL PSEUDARTHROSIS WITH OPEN REDUCTION AND INTERNAL FIXATION

Abstract

Aim: This retrospective study presents the results of humeral pseudarthrosis management, in our clinic, during the period 1997–2002.

Material: 21 patients with humeral pseudarthrosis were treated during this period. 7 were men, with an average age of 48, 6 (range 22–63) and 14 were women, with an average age of 63, 3 (range 42–80). The initial treatment in 19 cases was conservative and in 2 cases surgical (internal fixation with plate – screws or intramedullary nailing). The average time of the humeral pseudarthrosis management was 5,9 months (4–10 months).3 pseudarthrosis were oligotrophic and 18 atrophic.

Method: All patients underwent an open reduction, internal fixation and bone grafting (autografts and/or allografts).In humeral shaft pseudarthrosis a wide plate was applied, while in superior humeral metaphysis pseudarthrosis, a T-plate. In all cases impaction of the fracture edges was achieved.

Results: The average follow-up was 40,2 months (range 4–68 months).Union was achieved in all cases in an average of 2,8 months (range 2–8 months). Direct postoperative mobilisation and physical therapy was applied in 20 cases and only in 1 case a “Sarmiento” splint was applied for 3 weeks. In 2 cases a postoperative haematoma presented. In 1 case a pre-existed paresis of the radial nerve after the initial treatment of the fracture with internal fixation, came back 3 months after the management of pseudarthrosis and the release of the nerve. All patients’ revealed good functional rehabilitation, about 85–90% compared with the normal arm. Arm shortening in no case was greater than 2 cm.

Conclusion: Open reduction and internal fixation is the treatment of choice in the management of the humeral pseudarthrosis. The impaction of the fracture edges into each other strengthens significantly the stability of the fracture and promotes union.