title: Anterior augmentation plating of aseptic humeral shaft nonunions after intramedullary nailing.
abstract: BACKGROUND
  Humeral shaft nonunion after intramedullary nailing is a rare but serious complication. Treatment options include implant removal, open plating, exchange nailing and external fixation. The objective of this retrospective study was to determine whether augmentation plating without nail removal is feasible for treating a humeral shaft nonunion.
  
  
  METHODS
  Between 2002 and 2014, 37 patients (mean age 51, range 20-84 years) with aseptic humeral shaft nonunions prior to intramedullary nailing were treated with augmentation plating. The initial fractures had been fixed with retrograde nails (10 cases) or anterograde nails (27 cases). There were 34 atrophic nonunions and 3 hypertrophic nonunions. Nonunion treatment of all patients consisted of local debridement through an anterior approach to the humerus and anterior placement of the augmentation plates. Supplemental bone grafting was performed in all atrophic nonunion cases. All patients were followed until union was radiologically confirmed.
  
  
  RESULTS
  Union was achieved in 36 patients (97 %) after a mean of 6 months (range 3-24 months). There was one case of iatrogenic median nerve palsy that showed complete spontaneous recovery 6 weeks postoperatively. One patient sustained a peri-implant stress fracture that was treated successfully by exchanging the augmentation plate to bridge the nonunion and the fracture. No infections or wound healing complications developed. At a mean follow-up of 14 months, all patients showed free shoulder and elbow motion and no restrictions in daily or working life.
  
  
  CONCLUSIONS
  The results indicate that augmentation plating using an anterior approach is a safe and reliable option for humeral shaft nonunions after failed nailing, and the treatment has no substantial complications. Because the healing rates are similar to the standard technique of nail removal and fixation by compression or locking plates, we consider this technique to be an alternative choice for treatment.
authors: Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany. jangessmann@me.com.
authors: Jan
authors: J
authors: Gessmann
authors: Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
authors: Matthias
authors: M
authors: Königshausen
authors: Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
authors: Marlon Osman
authors: MO
authors: Coulibaly
authors: Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
authors: Thomas Armin
authors: TA
authors: Schildhauer
authors: Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
authors: Dominik
authors: D
authors: Seybold
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails / Q000009:adverse effects; D001860:Bone Plates / Q000009:adverse effects; D016025:Bone Transplantation; D003646:Debridement; D018483:Diaphyses / Q000601:surgery; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008297:Male; D020423:Median Neuropathy / Q000209:etiology; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D014945:Wound Healing; D055815:Young Adult
keywords: Anterior approach; Augmentation plating; Bone grafting; Humeral shaft nonunion; Intramedullary nailing