Outcome of Management of Humerus Diaphysis Non-union

Kingori J, Sitati C. "Outcome of Management of Humerus Diaphysis Non-union." East and Central African Journal of Surgery. 2009;14(2):15-16.


Background: The majority of diaphyseal humerus fractures heal uneventfully when treated nonoperatively,
however, nonunion is not a rare event. Nonunion after conservative treatment can
be successfully treated by open reduction and internal fixation. A nonunion of a diaphyseal
fracture of the humerus can present a major functional problem. The main of our study was to
document the outcome of management of non-united diaphyseal humerus fractures with plate
or plate and rush pin fixation. Methods: A 4 year retrospective study was undertaken at
Presbyterian Church of East Africa (PCEA) Kikuyu Hospital, Orthopedic Unit in Kenya from April
2004 to April 2008. Records of consecutive patients with nonunion of the humeral diaphysis were
reviewed. Four cases were lost to follow up. The rest were treated with a single posterior,
anterior or anterolateral plate while four with a plate and rush pin construct. Autogenous iliac
crest bone graft was utilised in most of the cases. A clinical evaluation for union, range of motion
and complications. Radiological assessment for union was also done. Results: A total of 46
patients with humerus diaphysis non-union met the inclusion criteria. Their ages ranged from 23
to 95 years with a mean of 43.6 years. The overall healing rate was 92.8 % (39/42 cases) at 6
months follow up. 3 failures occurred of whom one was a smoker and diabetic, another had a
loose plate and screws following replating. The third case went to nonunion. Three cases of
postoperative radial nerve palsy all of which resolved within six weeks were documented. All four
treated with a plate and rush pin construct healed uneventfully. Conclusion: The results of this
study indicate that our standard surgical procedure for treatment of nonunion of the humeral
shaft is reliable with a 92.8% union rate in our study with few complications. The plate and rush
pin construct is useful in dealing with nonunion involving osteoporotic bone.

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