Purpose of the study: Since the advent of locked centromedullary nailing, manufacturers have produced long nails with automatic distal locking systems. Astute instrumentations have been developed to achieve highly stable assemblies. But during insertion, the exact shape o the nail may change adapting to the anatomy of the medullary canal. We wanted to test a new automatic distal locking system: Surelock.

Material and methods: We conducted a preliminary monocentric prospective study over a one-month period where we included all cases of reconstruction of the proximal femur using a long nail. The Surelock system was applied systematically. The amplifier was needed to adjust the insertion device, the amplifier and the nail in the same plane. This configuration required manipulation of the amplifier in a single plane. The operator then had to correct the position of the insertion devise in accordance with the deformation of the inserted nail. It is noteworthy that with this system, the operator’s hands are never in the amplifier field. We measured the time required to achieve distal locking and the time of scopy, as well as any complications.

Results: During this period, ten patients had osteosynthesis with a long reconstruction nail. The epidemiological data were common for this type of condition. Mean time for the distal locking was 11 min (7–15) with a mean 17 s of scopy (2–24). In all cases, the two distal screws were inserted. The automatic locking was correct in 9 of 10 cases. The one failure was the second case in our series.

Discussion: In 2006, Whatling concluded a review of the literature on different means for distal locking that the search should continue for an ideal method and that by far the most widely used method was manual locking. The new method presented here for automatic distal locking allows implantation of two distal safety screws. The main benefit is for the surgeon and the manipulator of the amplifier. Radiation of the surgeon is nearly zero (the surgeon remains outside the amplifier field) and the manipulation to position the amplifier is simplified.

Conclusion: We believe that this technique could be used in routine practice and that this method could be proposed for the entire range of nailing procedures.

Introduction: Humerus non union is unfrequent, and reported series short. New fixation with or without autograft remain the gold standard to achieve bone union in 95% of cases. But no report are published in case of failure of that new procedure. 9 patients with a failure of autograft in humerus non union have been treated by new fixation an adjonction of BMP

Matériel et méthodes: 9 patients with an average age of 53,8 yo (24–71) have been treated and followed prospectively for a minimum time of 3 years. The delay between the fracture and the secon procedure was 31 months (6–103). The number of procedure after the fracture fixation was 1,4 (1–5). In 6/9 cases a technical pitfall during the initial procedure was pointed. In 3/9 cases a radial palsy associated with the initial fracture, a septic condition of the non union, general risk factors of non union (diabetes, tabac) and a non collaborative patient were reported.

Bone union was defined as the continuity of 4/4 cortex on Xray (AP and sagital plane) and or with ct scan. Osigraft^® (BMP7) was implanted in the resected zone of non union which was fixed with 2 plates after reaming and decortication.

Résults: No complication have been reported. One case failed (septic non union, 3 procedures, very active patient). The 8 last patients achieved bone union with a delay of 11,1 mois (6–14) without any additive procedure. The 3 septic cases have been solved. Shoulder and elbow function were good without nerves complications.

Discussion:: Autograft remains the gold standard in term of treatment of non union. But nothing is reported in humerus non union if iliac crest autograft have failed to achieve non union. In such an indication (failure after an autograft) and in such a level (humerus can be shorten) a stable fixation an a growth factor allowed to solve resistant cases of non union even in septic conditions.

The failure of the initial treatment of the fracture (unstable fixation, unfilled bone’s defect) remain the main cause of non union.