PAPER 162: HUMERAL NONUNIONS: USE OF THE PEDICLED LATERAL BORDER OF SCAPULA

Abstract

Purpose: Difficult nonunions of the humerus are frequently treated with free vascularized bone, usually the fibula, but donor site morbidity from the lower leg can be significant. The lateral border of the scapula is a 7–12 cm tubular length of vascular bone that can be easily transferred to the humerus.

Method: Nineteen established nonunions of the humerus, including mid-shaft (11), proximal (4), distal (3), and a failed shoulder fusion, were treated with a segment of scapula on a vascular pedicle. Patients (13 females, 6 males with average age of 63) had undergone 3 previous surgeries on average in attempts to heal the fracture. The time from injury to procedure averaged 28 months (range, 5–120 months). The surgical team consisted of an orthopedist and a plastic surgeon working simultaneously with the patient in a lateral position. The scapular graft was juxtaposed to the humerus through an axillary tunnel, then rigidly fixed with plate and screws and grafted with a calcium sulfate and bio-assayed demineralized bone matrix product (Allomatrix^™, Wright Medical Technology, Arlington TN).

Results: All nonunions healed, achieving radiographic evidence of consolidation between 8–24 weeks (average, 13 weeks). One patient with a previously infected non-union had recurrent infection and required further surgery before healing. Another patient fractured through the mid-portion of the healed graft in a fall two years after surgery and was revised to an endoprosthesis. Patient-based Musculoskeletal Tumor Society scores averaged 83% at 41 months (range, 24–66).

Conclusion: Pedicled transfer of the lateral border of scapula with circumflex scapular artery is an excellent choice for treating recalcitrant humeral nonunions. There were no complications at the donor site and all nonunions healed. Advantages of this procedure are:

• Surgery time