Background
Although the great majority of fractures of the mid-third of the humeral shaft heal uneventually when treated nonoperatively, nonunion is not a rare condition. The prevalence of nonunion as a complication of both nonoperative and operative treatment has been reported to be as high as 13%. Open reduction and plate fixation combined with autologous bone grafting can result in reliable healing of these humeral nonunions with excellent functional outcome.
Patients and methods
Between 2002 and 2007, 30 consecutive nonunion cases of the midpart of the humeral shaft were treated with open reduction and internal fixation by a single surgeon. The series included 14 female patients and 16 male patients with an average age of 42 years (range 19–57 years). The patients were followed up for an average of 28 months (range 24–56 months). The time from diagnosis of nonunion to our treatment of the nonunion averaged 9 months (range 6–24 months).
Result
According to the Stewart and Hundley Criteria, the functional postoperative result was excellent or good in 24 (73%) cases and fair in six (27%) cases. One year after surgery, all patients had an essentially normal range of motion of the ipsilateral elbow and shoulder. According to the scoring system of Constant and Murley the postoperative average score was 90 (range 88–96).
Conclusion
Surgical compression plating and autologous bone grafting of humeral diaphyseal nonunions resulted in 100% union rate and mostly excellent or good functional results without significant morbidity.