PAPER 7: SUCCESSFUL LOCKED NAILING WITH INTERFRAGMENTARY WIRING FOR HUMERAL NONUNIONS WITH OSTEOPOROSIS OR COMMINUTION

Abstract

Objective: For humeral nonunions, plating is threatened by severe osteoporosis or comminution. Locked nailing alone is threatened residual fracture gap and motion. In the present study, interfragmentary wiring was added to locked nailing for fragment compression to reduce the fracture gap and increase the fixation stability.

Materials and Methods: Locked nailing was augmented with figure-of-eight interfragmentary wiring for 62 consecutive non-infected humeral nonunions with osteoporosis or comminution. The average age of patients was 58.6 (26–87) years with an average nonunion duration of 18.5 (6–36) months. Nonunions were located at the proximal third in 10, middle third in 37, and distal third in 15. Fifty-six patients had previous operations including 38 platings and 18 nailings. Antegrade nailing was used in 39 and retrograde in 23. Thirty-two nonunions were nailed with 8-mm nails and thirty with 7-mm nails. Iliac bone autografts were used in 26 nonunions and allografts in 36. The average follow-up time was 35.8 (18–48) months.

Results: With a single operation, 60 patients achieved eventual union with an average time of 19.6 weeks. One of them had second revisional nailing and wiring because of wire breakage. Two patients still had a thin visible radiolucent line on radiographs 2 and 2.5 years respectively after operation, but their arm functions were satisfactory. Five patients had transient radial nerve palsies and no patients had deep infection. At follow-up, except 3 patients with associated pre-existing diseases, the average eventual Neer score (90.2) was significantly better than the average preoperative score (54.3). Three patients with retrograde nailing had residual extension loss of elbow joints, 8° in 1 and 5° in two, but there was no elbow function impairment. Two patients with shortening > 3 cm still had satisfactory arm function with minimal cosmetic problems. There were no signifiant differences about the healing rate and functional recovery between allograft group and autograft group. The main complication of graft donar site was immediate post-op pain.

Conclusions: Humeral nonunions with osteoporosis or comminution could be successfully treated by locked nailing with interfragmentary wiring. Allografts were as effective as autografts in achieve eventual union