Abstract
Introduction: The conventional treatment of humeral shaft nonunion is plating and cancellous bone grafting. This option is very efficient but not absolutly safe. In case of initial treatment by nailing, a secondary compression at the site of the fracture could be an alternative.
Materials and Method: Between January 2000 and december 2003, in a prospective study, 56 patients have been operated for an acute humeral shaft fracture using retrograde locking nailing (UHN®, Synthes™). 4 patients (7%) had an aseptic and tight nonunion. All of them were treated by secondary closed compression without bone graft. The mean age of the patients was 42 years-old at the procedure (range 17 to 73). All the patients were reviewed with clinical and radiological exams, using the DASH and Rommens scores and standard radiographs.
Results: No per or post operative complication occurred. Bone healing was obtained in all cases within 4 months. At an average follow-up of 66 months (range 51 to 74), the average DASH score was 29.6/100 (range 8.3 to 60.8) and the Rommens score was excellent in 3 patients and moderate in one because of history of Complex Regional Pain Syndrome.
Discussion and Conclusion: One of the characteristics of the retrograde nailing with UHN is to permit an initial or secondary axial compression at the site of the fracture. Secondary compression in the treatment of non union offers the advantages of a closed procedure which avoids any radial nerve injury, and preserves the bone vascular supply. In the present preliminary series, the isolated secondary compression appeared as a simple and safe procedure which allowed bone healing in all cases.
Correspondence should be addressed to: EFORT Central Office, Technoparkstrasse 1, CH – 8005 Zürich, Switzerland. Tel: +41 44 448 44 00; Email: office@efort.org
Author: Thomas Apard, France
E-mail: thomasapard@yahoo.fr
