title: Comparison of three different treatment modalities in the management of humeral shaft nonunions (plates, unilateral, and circular external fixators).
abstract: OBJECTIVE
  To compare 3 different fixation methods for the treatment of humeral shaft nonunions in terms of union time, functional outcome, and complications.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Between 1996 and 2004, 80 patients (mean age, 49; range, 15 to 86; 30 women and 50 men) with nonunions of the humeral shaft were treated surgically in our institution. Circular external fixators (CEF) were used in 35 patients, unilateral limb reconstruction system (LRS) fixators in 24 patients and fixation with plates in 21 patients.
  
  
  METHODS
  Surgical procedure included hardware removal in previously operated patients, autogenous grafting in all patients in the plate group and in those patients with atrophic nonunions in the external fixator groups, compression of the nonunion site in all patients.
  
  
  METHODS
  Radiological union time, complications, shortening, and disabilities of the arm, shoulder, and hand (DASH) score.
  
  
  RESULTS
  Mean follow-up period was 48.1 months (range, 12 to 121). Mean radiological union time was 5.5 months (range, 1.5 to 12) in the CEF group, 5.2 months (range, 3 to 10) in the LRS group, and 5.7 months (range, 3 to 12) in the plate group. Mean DASH score was 23.7 in the CEF group, 18.6 in the LRS group, and 26 in the plate group. There were no statistical differences in terms of union time and the DASH score among the 3 groups. Successful union was achieved in 77 (96.3%) patients.
  
  
  CONCLUSIONS
  Both external fixation and plate fixation produce excellent results in humeral shaft nonunions if applied properly. The procedure can be tailored to the surgeon's experience, keeping in mind that plate fixation demonstrates a longer healing time in those cases that had previous surgeries.
authors.affiliation: Istanbul University, Istanbul Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul, Turkey. atalar@istanbul.edu.tr
authors.forename: Ata Can
authors.initials: AC
authors.lastname: Atalar
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kocaoglu
authors.forename: Mehmet
authors.initials: M
authors.lastname: Demirhan
authors.forename: Kerem
authors.initials: K
authors.lastname: Bilsel
authors.forename: Levent
authors.initials: L
authors.lastname: Eralp
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation* / Q000379:methods; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012086:Reoperation / Q000295:instrumentation; D012189:Retrospective Studies; D016896:Treatment Outcome