Locking plate fixation with or without auto-iliac graft for humeral shaft nonunion / 中华创伤骨科杂志

ABSTRACT

Objective To evaluate the clinical outcomes of open reduction and locking plate fixation with or without auto-iliac graft for humeral shaft nonunion.Methods Between January 2008 and May 2012,65 cases of humeral shaft nonunion were treated in our department.They were 48 men and 17 women,24 to 54 years of age (39.8 years).Of them,43 were atrophic and 22 hypertrophic.The radial nerve was exposed and protected during operation.After the nonunion portion was debrided,the humeral length was recovered.Next the fracture sites were fixated by a locking plate.The defected area was filled with auto-iliac graft if necessary.The visual analogue scale (VAS) scores and The Short Form-36 (SF-36) scores were documented after operation; the functional recovery was evaluated using Constant scoring at the last follow-up.Results The patients obtained a mean follow-up of 13.8 months (from 10 to 32 months).Of them,50 achieved clinical bone union after an average of 3.8 months (from 3 to 7 months).The remaining 6 cases showed no sign of union 9 months postoperatively.Of the 50 patients with union,the mean VAS score was decreased significantly from the preoperative 5.1 ± 3.2 points to the postoperative 1.4 ± 0.8 points,and the mean SF-36 score was increased significantly from the preoperative 45.7 ± 16.9 points to the postoperative 72.9 ± 18.5 points (P ＜ 0.05).The function was scored at the last follow-up as excellent in 34 cases,good in 12,fair in 2 and poor in 2,giving an excellent to good rate of 92.0％.The radical nerve injury was repaired within 3 months postoperation in 3 patients.Rotation deformity occurred in 3 cases without obvious functional limitation.No implant complications such as plate breakage and screw loosening were observed.Conclusion Open reduction and locking plate fixation with or without auto-iliac graft is one effective treatment of humeral shaft nonunion,but damage to the radial nerve should be avoided and fixation of 6 layers of cortex should be maintained at both fracture ends during operation