title: Persistent non-union of the humeral shaft treated by plating and autologous bone grafting.
abstract: Surgical treatment of persistent non-union of the humeral shaft is a complex situation because of the risk of failure and surgery-related complications. The primary objective of this study was to evaluate clinical and radiological results of a continuous series of persistent non-union treated with plating and bone grafting. The secondary objective was to expose factors contributing to the failure of prior bone union attempts.
  
  
  
  Sixteen patients (average age of 52 years) were treated for persistent non-union of the humeral shaft in our department; six of these patients had predisposing comorbidities or addictions. The persistent non-union was treated by plating with autologous bone graft from the iliac crest in a single-stage procedure in 12 cases and a two-stage procedure in three cases; one case was treated with plating and vascularized fibula graft.
  
  
  
  At a minimum follow-up of 12 months (average 78 months), four (25 %) failed to heal. The 12 other patients had bone union after an average of eight months. The average QuickDASH score was 48 points (18-72). A retrospective analysis of the prior attempts to treat the non-union revealed three cases of unstable fixation, four cases with no osteogenic supply and seven cases of positive microbiological cultures at the non-union site.
  
  
  
  Plating and autologous bone grafting resulted in union in only 75 % of persistent non-union of the humeral shaft. The persistent nature of the humeral shaft non-union could be attributed to deviating from validated rules for surgical treatment and/or the presence of a surgical site infection.
authors: Orthopaedic, University Hospital, Place Baylac, Toulouse, 31059, France.
authors: Tristan
authors: T
authors: Pollon
authors: Orthopaedic, University Hospital, Place Baylac, Toulouse, 31059, France.
authors: Nicolas
authors: N
authors: Reina
authors: Orthopaedic, University Hospital, Place Baylac, Toulouse, 31059, France.
authors: Stéphanie
authors: S
authors: Delclaux
authors: Orthopaedic, University Hospital, Place Baylac, Toulouse, 31059, France.
authors: Paul
authors: P
authors: Bonnevialle
authors: Orthopaedic, University Hospital, Place Baylac, Toulouse, 31059, France.
authors: Pierre
authors: P
authors: Mansat
authors: Orthopaedic, University Hospital, Place Baylac, Toulouse, 31059, France. nicolasbonnevialle@yahoo.fr.
authors: Nicolas
authors: N
authors: Bonnevialle
mesh_terms: D000368:Aged; D001860:Bone Plates / Q000009:adverse effects*; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005360:Fibula / Q000637:transplantation; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D006811:Humerus / Q000601:surgery; D007085:Ilium / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014182:Transplantation, Autologous / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: Bone graft; Fracture; Humeral shaft; Non-union; Plating