title: Treatment of nonunions in fractures of the humeral shaft according to the Diamond Concept.
abstract: METHODS
  Between 2005 and 2012, 50 patients (23 female, 27 male) with nonunion of the humeral shaft were included in this retrospective study. The mean age was 51.3 years (14 to 88). The patients had a mean of 1.5 prior operations (sd 1.2;1 to 8). All patients were assessed according to a specific risk score in order to devise an optimal and individual therapy plan consistent with the Diamond Concept. In 32 cases (64%), a change in the osteosynthesis to an angular stable locking compression plate was performed. According to the individual risk an additional bone graft and/or bone morphogenetic protein-7 (BMP-7) were applied.
  
  
  RESULTS
  A successful consolidation of the nonunion was observed in 37 cases (80.4%) with a median healing time of six months (IQR 6). Younger patients showed significantly better consolidation. Four patients were lost to follow-up. Revision was necessary in a total of eight (16%) cases. In the initial treatment, intramedullary nailing was most common.
  
  
  CONCLUSIONS
  The use of locking compression plates in combination with autologous cancellous bone graft has been shown to be a safe and effective treatment. In more complex cases, the use of the Masquelet technique and BMP-7 may be indicated at the first revision operation.
  
  
  CONCLUSIONS
  Our results suggest the Diamond Concept is a successful treatment strategy for nonunions of the humeral shaft.
authors.affiliation: Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Miska
authors.affiliation: Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Findeisen
authors.affiliation: Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Tanner
authors.affiliation: University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen am Rhein, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Biglari
authors.affiliation: University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen am Rhein, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Studier-Fischer
authors.affiliation: University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen am Rhein, Germany.
authors.forename: P A
authors.initials: PA
authors.lastname: Grützner
authors.affiliation: Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Schmidmaier
authors.affiliation: Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Moghaddam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D005599:Fractures, Ununited / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult
keywords: Diamond Concept; Fracture Healing; Fracture of the Humeral Shaft; Nonunion; Pseudoarthrosis