Abstract
Aim
The purpose of the study was to assess the outcomes of the surgical management of humeral shaft non-unions.
Method
Between 2002 and 2010, 23 patients with humeral shaft non-unions underwent revision surgery. Nine were initially treated non-operatively, 11 with a plate, 1 with screws and 2 with an intramedullary nail.
In previously operated patients with aseptic non-unions single stage revision was performed, while septic non-unions underwent a two stage revision. Revision stabilisation was by single or double plate fixation +/− external fixator, depending on bone loss and bone quality. Augmentation of fixation was with iliac crest bone graft in all cases.
Data collected from the case notes and radiographs included: smoking habits, type and site of non-union, bone loss, infected or not, organism isolated, definitive stabilisation, augmentation used, post operative complications, further surgical interventions and time to radiological union.
Results
There were 12 females and 11 males with an average age of 49 years (19–87 years). All but one were initially closed fractures. 12/23 smoked at least 15 cigarettes/day. Mean time from injury to revision surgery was 11 months. Sites of non-union were mid third (10), proximal third (8) and distal third (5).
10/14 in the previous surgery group were infected and underwent two stage revision. Average time to radiological union was 5 months in the uninfected group and 9 months in the infected group. Successful union was achieved in all cases in the uninfected group (100%) and all but two case in the infected group (91%). Four patients needed unanticipated further interventions to achieve union. At discharge all successfully treated patients had good shoulder and elbow function.
Conclusion
Successful union of humeral shaft non-unions can be achieved with double plate fixation and augmentation with ICBG. This has reduced the need for supplementary external fixation
