Session IV - Upper Extremity

Fri., 10/21/05 Upper Extremity, Paper #12, 9:15 am

Plate ORIF of Humeral Shaft Nonunions: Is Healing Dependent on Type of Bone Graft?

Christian Hierholzer, MD; Jose B. Toro-Arbelaez, MD;
Domenico Sama, MD; David L. Helfet, MD (n-all authors);
Hospital for Special Surgery, New York, New York, USA

Purpose: Delayed union or nonunion of the humerus following fractures is an infrequent but debilitating complication often leading to a painful upper extremity with limited function. We tested the hypothesis that healing of atrophic or oligotrophic aseptic humeral delayed union or nonunion would be similarly achieved by a standard protocol of plate open reduction and internal fixation (ORIF) and bone graft, either autologous or allograft, and reviewed a consecutive retrospective cohort series.

Methods: Between 1992 and 1999, 46 patients (age 50.0 years) with aseptic atrophic or oligotrophic nonunions were treated with plate ORIF and autologous iliac crest bone graft (ICBG). Time of nonunion was 13.8 months and mean follow-up was 32.6 months. The subsequent protocol remained the same, but the bone graft used was changed to DBM-Grafton. Between 2000 and 2003, 34 patients (age 59.2 years) were treated with plate ORIF and DBM-Grafton. Time of nonunion was 22.1 months and mean follow-up was 19.8 months. (All values represent means.)

Results: All patients included in this study demonstrated healing of delayed unions and nonunions both clinically and via radiologic assessment. Time to union was 4.5 months in the ICBG and 4.1 months in the DBM-Grafton group. Functional outcome did not differ between the two groups. In the ICBG group, 3 patients required revision humeral surgery: 1 irrigation/debridement due to deep infection, 1 manipulation under anesthesia of the elbow, and 1 removal of hardware. Two patients demonstrated persistent radial nerve dysesthesia at the last follow-up. Furthermore, 37% of the ICBG group patients had prolonged donor site iliac pain and 1 patient had a superficial infection requiring irrigation and debridement. Complications in the DBM- Grafton group included 1 superficial humeral infection.

Conclusions: ORIF according to a standard protocol of osteosynthesis consistently resulted in healing of atrophic or oligotrophic aseptic delayed unions or nonunions of the humeral shaft. The results of this study suggest that healing of atrophic or oligotrophic aseptic humeral shaft delayed unions or nonunions is dependent on surgical technique using rigid plate fixation, lag screw compression, and bone graft, but is independent of the use of autologous or allograft augmentation.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.