title: Management of nonunions of the proximal humeral diaphysis.
abstract: It has been reported that the majority of nonunions of the humeral shaft evaluated are within the proximal one-third of the diaphysis. We are not aware of any reported series of humeral nonunions dealing specifically with the proximal diaphysis. We therefore sought to identify patients with a humeral shaft nonunion from an orthopaedic trauma service database, determine the frequency of those within the proximal one-third and review our treatment strategy and resulting clinical outcomes for these difficult fractures. Clinical and radiographical follow-up was available for 19 patients with a mean age of 70 years (range 29-94 years). This represented 46% of all humeral shaft nonunions treated during the study period. Dual plating was used in 11 cases to get adequate fixation in the proximal segment. Post-operative alignment was within 5° of anatomic in all cases. All nonunions healed at an average of 15.2 weeks (range 8-36 weeks). The mean length of follow-up was 12.5 months (range 6-122 months). All patients reported significant improvement in pain. The mean range of motion following fracture union was forward flexion 137°, external rotation 41° and internal rotation 30°. There were two minor complications and neither required a secondary surgery. The surgical technique we have used emphasising a thorough debridement of the nonunion site, correction of the deformity, fracture site compression with a rigid construct and bone grafting provides excellent rates of union and clinical outcomes.
authors.affiliation: Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA. markprasarn@yahoo.com
authors.forename: Mark L
authors.initials: ML
authors.lastname: Prasarn
authors.forename: Timothy
authors.initials: T
authors.lastname: Achor
authors.forename: Omesh
authors.initials: O
authors.lastname: Paul
authors.forename: Dean G
authors.initials: DG
authors.lastname: Lorich
authors.forename: David L
authors.initials: DL
authors.lastname: Helfet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018483:Diaphyses / Q000293:injuries / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D017102:Fracture Healing / Q000502:physiology*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016896:Treatment Outcome