title: Management of a humeral shaft non-union after a Gustilo III C fracture.
abstract: A 25-year-old man was admitted to our Department with an open humeral shaft fracture (Gustilo III C); two large wounds were noticed with ulnar artery and median nerve completely dissected. Initial primary treatment included irrigation, debridement and fracture stabilization with a monolateral external fixator followed by vascular and nerve repair and wound closure. At 6 months follow up the patient was able to use his arm without any painful stimuli and a CT scan showed the presence of postero-medial callus formation. Consequently, the external fixator was removed and the patient was discharged to physiotherapy. After 7 months, the patient presented with severe pain and functional impairment with no history of trauma. X rays showed recent re-fracture on a background of oligotrophic nonunion. Revision surgery included debridement of the non-union bone edges, reaming of the medullary canal and insertion of a humeral nail. Six months later osseous healing was noted with complete restoration of shoulder and elbow movement and partial recovery of the median nerve.
authors.affiliation: Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Conserva
authors.affiliation: Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy. Electronic address: dott.gvicenti@gmail.com.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vicenti
authors.affiliation: Department of Orthopaedics and Traumatology, Monsignor Dimiccoli Hospital, Barletta, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Abate
authors.affiliation: Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Pesce
authors.affiliation: Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy.
authors.forename: Biagio
authors.initials: B
authors.lastname: Moretti
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001858:Bone Nails; D001860:Bone Plates; D016267:External Fixators; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008475:Median Nerve / Q000293:injuries*; D020423:Median Neuropathy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome; D017535:Ulnar Artery / Q000293:injuries*
chemical_list: D000900:Anti-Bacterial Agents
keywords: distal radius fractures; elderly patients; external fixation; open reduction internal fixation; volar locking plates