title: Plating, nailing, external fixation, and fibular strut grafting for non-union of humeral shaft fractures.
abstract: OBJECTIVE
  To compare various treatment modalities (plating, Ilizarov external fixation, and non-vascular fibular cortical strut grafting) for non-union of humeral shaft fractures.
  
  
  METHODS
  Records of 9 women and 26 men aged 24 to 71 (mean, 42) years who presented with non-union of humeral shaft fractures were reviewed. The humeral shaft fractures were secondary to low-energy trauma (n=22) or vehicular accidents (n=13) and involved the proximal (n=9), middle (n=15), and distal (n=11) regions. 13 of the fractures were open. Infection was evident in 8 of the non-unions. For non-unions with infection (n=8), a 2-stage procedure entailing temporary Ilizarov fixation followed by plating was used. For non-unions without infection (n=23), one-stage plating and cancellous bone grafting was used. For non-unions of osteoporotic bone (n=4), one-stage non-vascularised fibular strut grafting was used. Outcome was measured using the Disabilities of the Arm, Shoulder and Hand (DASH) scoring system.
  
  
  RESULTS
  The 35 patients were followed up for a mean of 16 (range, 6-60) months. All achieved bone union except for one (who had persistent infection). Respectively for non-unions with infection, nonunions without infection, and non-unions of osteoporotic bone, the mean times to bone union were 6.5 (range, 4-10), 5 (range, 4-8), and 10 (range, 6-14) months, the mean improvement in DASH score was 30, 43, and 18, and malalignment was noted in 5, 2, and one patient. Three patients had a preoperative radial nerve palsy for which standard tendon transfer was performed 6 weeks after treatment for non-union.
  
  
  CONCLUSIONS
  Compression plating achieved the best results. An external fixator may be used temporarily for infected non-unions. Fibular strut grafting may be used when non-unions warrant additional stability.
authors.affiliation: Department of Orthopedic Surgery, Post Graduate Institute of Swasthiyog Pratishthan, Miraj, Maharashtra, India.
authors.forename: Kedar P
authors.initials: KP
authors.lastname: Padhye
authors.forename: Vidhisha S
authors.initials: VS
authors.lastname: Kulkarni
authors.forename: G S
authors.initials: GS
authors.lastname: Kulkarni
authors.forename: Milind G
authors.initials: MG
authors.lastname: Kulkarni
authors.forename: Sunil
authors.initials: S
authors.lastname: Kulkarni
authors.forename: Ruta
authors.initials: R
authors.lastname: Kulkarni
authors.forename: Mayur D
authors.initials: MD
authors.lastname: Patil
authors.forename: Priyanka Y
authors.initials: PY
authors.lastname: Ravi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D001860:Bone Plates; D016025:Bone Transplantation; D016267:External Fixators; D005260:Female; D005360:Fibula / Q000637:transplantation*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006811:Humerus / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Ilizarov technique; bone transplantation; external fixators; fibula; fractures, ununited; humeral fractures