Union rate after operative treatment of humeral shaft nonunion--A systematic review.
BACKGROUND
Humeral shaft nonunions can lead to morbidity from subsequent operations, complications and impaired function. Currently there is no evidenced-based consensus for treatment of humeral shaft nonunions.


OBJECTIVE
We aimed to summarize and analyze union rates and complications after operative treatment for humeral shaft nonunion.


METHODS
Studies investigating operative treatment strategies for humeral shaft nonunion were identified by searching: EMBASE, MEDLINE, Ovid SP, Web of Science, Cochrane Central, PubMed and Google Scolar up to October 24, 2014. Studies were eligible if: (1) outcome of operative treatment for humeral shaft nonunion was reported; (2) at least ten adult patients with humeral shaft nonunion included; (3) full text article available; (4) written in English, German or Dutch; and (5) nonunion was defined as no bone-bridging between the fracture ends after 6 months.


RESULTS
Thirty-six studies were included. A union rate of 98% was found in patients (n=672) who underwent plate fixation with autologous bone grafting (ABG), 95% in plate fixation without ABG (n=19), 88% in intramedullary nailing with ABG (n=164), 66% in intramedullary nailing without ABG (n=78), 92% in bone strut fixation (n=91) and 98% in external fixation (n=152). A total complication rate of 12% was found in patients treated with plate fixation combined with ABG, 15% in intramedullary nail with ABG and 8% intramedullary nailing without ABG, 20% in bone strut fixation and 22% in external fixation.


CONCLUSIONS
Plate fixation with ABG was recommended for humeral shaft nonunion, since the union rate is highest and the complication rate is relatively low.


METHODS
Level IV.
University of Groningen, Department of Orthopaedic Surgery, University Medical Center Groningen Hanzeplein 1, 9713 GZ Groningen, The Netherlands. Electronic address: rinnepeters27@hotmail.com.
Rinne M
RM
Peters
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.
Femke M A P
FM
Claessen
University of Amsterdam, Orthopaedic Residency Program (PGY 5), Orthotrauma Research Center, Amsterdam, The Netherlands.
Job N
JN
Doornberg
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.
Gregory P
GP
Kolovich
University of Groningen, Department of Orthopaedic Surgery, University Medical Center Groningen Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
Ron L
RL
Diercks
Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Michel P J
MP
van den Bekerom
D001858:Bone Nails; D001860:Bone Plates; D005594:Fracture Fixation, Intramedullary / Q000379:methods / Q000706:statistics & numerical data; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome
Humeral shaft; Nonunion; Treatment; Union rate