title: Treatment of the humeral shaft nonunion after surgical failure using the Selfdynamisable internal fixator.
abstract: BACKGROUND
  A nonunion of the humeral shaft is not a rare condition and is a complication of both nonoperative and operative treatment of the fracture. Several fixation options were used in the nonunion treatment, including various plate techniques, intramedullary nails and external fixator. We applied our Selfdynamisable internal fixator for the treatment of humeral shaft nonunion after surgical failure and evaluated its clinical outcome.
  
  
  METHODS
  Six patients with persistent atrophic nonunion of the humeral shaft were treated with Selfdynamisable internal fixator. The inclusion criteria were mobile, unstable resistant nonunion of the humeral diaphysis which persisted after surgical treatment for nonunion. All patients were men with a mean age of 32 (27-39) years. The initial fracture treatment was external fixator in two patients and plaster cast for four patients. All cases failed to unite after primary treatment. Plate fixation was resorted for fracture union but failed. The revision surgery consisted of removal of hardware, freshening of bone ends and bone grafting, and internal fixation with a Selfdynamisable internal fixator.
  
  
  RESULTS
  The average follow-up was 33 months. All the nonunions healed after indexed operation. The average time for union was 5.5 months (range 4-9 months). There was no loosening or breakage of the fixation device. The functional results, according to the scale of Constant and Murlay modified by Ring, were excellent in five and good in one patient. There were no complications of nerve injuries or infections related to the operation.
  
  
  CONCLUSIONS
  Selfdynamisable internal fixator with bone graft for the treatment of recalcitrant humeral shaft nonunion provided successful clinical outcome with minimal complications.
authors: Clinic for orthopaedic surgery and traumatology, Faculty of Medicine, Clinical Center Nis, Bul. Dr Zorana Djindjica 48, 18000 Nis, Serbia. ivanmicic2000@yahoo.com
authors: Ivan
authors: I
authors: Micic
authors: Milorad
authors: M
authors: Mitkovic
authors: Desimir
authors: D
authors: Mladenovic
authors: Milos
authors: M
authors: Stanojlovic
authors: In Ho
authors: IH
authors: Jeon
mesh_terms: D000328:Adult; D004867:Equipment Design; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D007085:Ilium / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D012086:Reoperation; D017211:Treatment Failure