MANAGEMENT AND OUTCOME OF UNUNITED FRACTURES OF THE HUMERUS

Abstract

We have reviewed the management and outcome of ununited fractures of the humerus in a specialist limb reconstruction unit. A retrospective study conducted at Kings College Hospital, including referrals during the period September 1994 to present. There were 47 cases of humeral non-union, (14 proximal, 25 diaphyseal and eight distal). The time of referral from injury ranged from two months to eight years, with one patient referred after 37 years. 38 of the 47 patients had undergone an average of 1.08 operations prior to referral. Treatment aimed to achieve alignment, stability and stimulation. Methods were as follows: Proximal fractures [14]: nine Locked Compression Plate (LCP), five Dynamic Compression Plate (DCP). Autologous bone graft alone [eight], Bone Morphogenic Protein (BMP – Osigraft) alone [three], both bone graft and BMP [three]. 13 have united. One is under treatment. Mean time to union was six months. Diaphyseal fractures [25]: 12 LCP, four DCP, five Intramedullary (IM) nail, one Ilizarov frame and one required observation only. Autologous bone graft alone [17], BMP alone [two], both bone graft and BMP [three]. 23 have united. One patient awaits surgery. One patient declined surgery. Mean time to union was four months. Distal fractures [eight]: four LCP, two DCP, two Ilizarov frames. Autologous bone graft alone [seven], both bone graft and BMP [one]. Seven have united. One is under treatment. Mean time to union was seven months. Open reduction and appropriate stabilisation, together with the stimulus of autologus bone graft and/or BMP consistently resulted in healing of ununited fracture of the humerus. Many treatment methods were employed. It is not clear whether it was the treatment method or the accumulated experience of the Limb Reconstruction Unit, which was responsible for a high success rate comparable to, or better than, published results.