Surgical management of non-union of humeral diaphyseal fracture

ABSTRACT

To evaluate results of operative management of established non-union of humeral diaphysis with Dynamic compression plating [DCP] and Rush pinning with cancellous bone graft. Hospital based prospective study. Conducted at Department of Orthopedic Surgery, Jinnah Postgraduate Medical Centre, Karachi. A total of 21 patients of established un-united humeral diaphyseal fracture, between 15 to 65 years were included in this study. Patients underwent DCP and Rush pinning with bone grafting. Union of fractures clinico-radiographically and functional outcomes with Modified Constant and Murley Scale for shoulder and range of motion for elbow were considered. Among 18 available patients, 14/18 nonunion [77.8%] united within 5.1 +/- 1.8 months. For DCP group 11/13 [84.6%] united in 4.45 +/- 0.96 months. For Rush pin group 3/5 [60%] united in 7.7 +/- 2.1 month [P< 0.001]. Modified Constant and Murley Scale for shoulder assessment, for DCP group, excellent 05, good 03, fair for 03, poor 02 and for Rush pin group excellent 00, good 00, fair 02 and poor 03. Average range of motion of elbow joint 71.7 +/- 15.3% to 82.7 +/- 16.0%. Persistent non-union in four, radial nerve palsy in one, implant failure in two and shoulder impingement in one case noticed. No severe deep infection occurred. Dynamic compression platting with bone graft has shown significantly higher union rate for non-union of humeral diaphysis, while the functional outcome regarding shoulder [P<0.03] and elbow movements [P<0.05] are also proved to be significantly better in DPT as compared to Rush pin