Nonunion of humeral shaft fractures following flexible intramedullary nail fixation

Abstract

Introduction: The treatment of humeral shaft fractures ranges from conservative modalities to operative fixation, including plate osteosynthesis and intramedullary fixation. Nonunion is a complication of conservative and operative interventions but is more often associated with elastic nailing. This article discusses the successful outcomes for treatment of nonunion of humeral shaft fracture achieved by Locking Compression Plate (LCP) with autogenous bone grafting. Methods: Fifteen cases of nonunion of humeral shaft fracture primarily treated with Elastic nail were included in this study. The study population comprised 12 males and 3 females with an average age of 31.2 years with minimum follow up of 12 months. Eleven fractures were defined as atrophic nonunion, and 4 as hypertrophic. All fractures were managed by open reduction and internal fixation with LCP and autogenous cancellous bone graft with mean follow-up period of 14 months. Results: All cases showed union at subsequent follow-up with an average of 14 weeks (range 12-16 weeks). Complications included one patient with radial nerve neuropraxia which recovered spontaneously within 3 months of surgery, and a patient with superficial wound infection which was managed by debridement and antibiotics. At the final follow-up, shoulder and elbow functions of the operated limbs were satisfactory (4 Excellent, 11 Good results with an average ASES score of 46). Conclusion: Fixation by LCP with cancellous bone graft is reliable and effective treatment for nonunion of humeral shaft fracture. The combined use of LCP and autogenous cancellous bone graft is able to achieve both rigid fixation and improve osteogenesis