Allografting in locked nailing and interfragmentary wiring for humeral nonunions.
In this prospective study, we compared outcomes after repair of humeral nonunions when morsellized fresh-frozen allograft or autograft was used to augment repair by intramedullary nailing. Sixty-five patients with humeral shaft nonunions of greater than 6 months' duration and gross instability at the nonunion site were included and treated by locked nailing, interfragmentary wiring, and bone grafting. Graft type was determined by patient preference. Outcomes assessed included union rate and functional recovery of the arm. Secondary end points included operative blood loss, operation time, hospital stay, time to fracture healing, and complications. Twenty-eight patients with autografts and 36 with allografts were followed up more than 2 years. The baseline conditions of the two groups were similar. The autograft group had greater blood loss and longer operative time than the allograft group. The autograft group also had a longer hospital stay. The healing rate, time to healing, and functional scores did not differ between these two groups. In the autograft group, 43% reported pain and limited mobility as a result of the donor site. We concluded that when used in association with locked nailing for humeral nonunions, allografts can achieve treatment results similar to autografts but without donor site complications.


METHODS
Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
Lin
Wei-Peng
WP
Department of Orthopedic Surgery, National Taiwan University Hospital, No 7 Chung Shan S Road, Taipei 100, Taiwan.
Lin
Jinn
J
D000328:Adult; D016063:Blood Loss, Surgical; D001858:Bone Nails; D016025:Bone Transplantation / Q000379:methods*; D001864:Bone Wires; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000503:physiopathology / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D020127:Recovery of Function; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome
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