TREATMENT OF NON-UNION OF FRACTURES OF THE NECK OF THE HUMERUS BY USING FIBULAR ALLOGRAFT

Abstract

Purpose of study: A retrospective review of treatment for this often very difficult problem in old people with osteoporotic bone.

Description of methods: Number of patients reviewed: 11 (9 females, 2 males). Age: 63 – 89 (average 76). Follow-up: 14 – 72 months (average 61)

The operative method was similar in all cases: the non-union was exposed through a delto pectoral approached and fibular allograft was inserted across the fracture site. As the fibula is a very dense cortical bone a T-plate could then be applied to the humerus with the screws directed into the intramedullary fibular peg. Cortico-cancellous bone from the Iliac crest was supplemented.

Results: Bony union was achieved in every case.

Pre-operative constant scores: Average 26

Post-operative constant scores: Average 75

The most significant increase in constant score was the ability to actively elevate the arm. Decrease in pain levels did play a role but was not as dramatic as the increase in function.

Discussion: In this very difficult problem of non-union of the proximal humerus, mostly in elderly people with osteo-porotic bone where internal fixation is a major problem, supplementing the fixation with an intramedullary fibular peg achieved excellent results.