title: Revision with plates of humeral nonunions secondary to failed intramedullary nailing.
abstract: OBJECTIVE
  The objective of this study was to evaluate the results achieved after revision with plates of humeral nonunions secondary to failed intramedullary nailing.
  
  
  METHODS
  We retrospectively evaluated 32 patients with humeral nonunions secondary to failed intramedullary nailing, treated by internal fixation with plates between 1998 and 2012. Nonunions were diaphyseal in 19 cases, they were located in the proximal humeral metaphysis in nine cases, and in the distal humeral metaphysis in four cases. There were 11 atrophic nonunions and 21 oligotrophic nonunions. Initial treatment was performed with static locked nails in 12 cases, nails with expansive locking systems in 11 cases, and using thin elastic nails in nine cases. The nails were placed antegrade in 18 cases and retrograde in 14 cases. Time between initial surgery and revision surgery averaged 14.5 months. In seven diaphyseal nonunions, the intramedullary nail was left in-situ. Bone graft was added in 25 cases.
  
  
  RESULTS
  Follow-up averaged 35 months. Union was achieved in all cases, after an average of 3.8 months. Disabilities of the Arm, Shoulder and Hand (DASH) score at last follow-up averaged 14 points, and Constant's score averaged 82 points. The analogue scale of pain averaged 0.8 points. Out of seven patients with radial nerve compromise, six recovered completely and one needed tendon transfers.
  
  
  CONCLUSIONS
  Revision with plates after failed intramedullary humeral nailing achieved union and good predictable objective and subjective results in all cases. Adequate implant selection and meticulous surgical technique are necessary to achieve successful osteosynthesis and bony union.
authors.affiliation: Instituto de Cirugía Reconstructiva de los Miembros, Sanatorio Allende, Córdoba, Argentina, christian_allende@hotmail.com.
authors.forename: Christian
authors.initials: C
authors.lastname: Allende
authors.forename: Agustín
authors.initials: A
authors.lastname: Paz
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Altube
authors.forename: Hernán
authors.initials: H
authors.lastname: Boccolini
authors.forename: Alejandro
authors.initials: A
authors.lastname: Malvarez
authors.forename: Bartolomé
authors.initials: B
authors.lastname: Allende
mesh_terms: D016025:Bone Transplantation; D004551:Elbow Joint / Q000503:physiopathology; D005260:Female; D005593:Fracture Fixation, Internal; D005594:Fracture Fixation, Intramedullary; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008297:Male; D011826:Radial Nerve / Q000503:physiopathology; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure