Anterior augmentation plating of aseptic humeral shaft nonunions after intramedullary nailing View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2016-05

AUTHORS

Jan Gessmann, Matthias Königshausen, Marlon Osman Coulibaly, Thomas Armin Schildhauer, Dominik Seybold

ABSTRACT

INTRODUCTION: Humeral shaft nonunion after intramedullary nailing is a rare but serious complication. Treatment options include implant removal, open plating, exchange nailing and external fixation. The objective of this retrospective study was to determine whether augmentation plating without nail removal is feasible for treating a humeral shaft nonunion. MATERIALS AND METHODS: Between 2002 and 2014, 37 patients (mean age 51, range 20-84 years) with aseptic humeral shaft nonunions prior to intramedullary nailing were treated with augmentation plating. The initial fractures had been fixed with retrograde nails (10 cases) or anterograde nails (27 cases). There were 34 atrophic nonunions and 3 hypertrophic nonunions. Nonunion treatment of all patients consisted of local debridement through an anterior approach to the humerus and anterior placement of the augmentation plates. Supplemental bone grafting was performed in all atrophic nonunion cases. All patients were followed until union was radiologically confirmed. RESULTS: Union was achieved in 36 patients (97 %) after a mean of 6 months (range 3-24 months). There was one case of iatrogenic median nerve palsy that showed complete spontaneous recovery 6 weeks postoperatively. One patient sustained a peri-implant stress fracture that was treated successfully by exchanging the augmentation plate to bridge the nonunion and the fracture. No infections or wound healing complications developed. At a mean follow-up of 14 months, all patients showed free shoulder and elbow motion and no restrictions in daily or working life. CONCLUSIONS: The results indicate that augmentation plating using an anterior approach is a safe and reliable option for humeral shaft nonunions after failed nailing, and the treatment has no substantial complications. Because the healing rates are similar to the standard technique of nail removal and fixation by compression or locking plates, we consider this technique to be an alternative choice for treatment. More... »

PAGES

631-638

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00402-016-2418-8

DOI

http://dx.doi.org/10.1007/s00402-016-2418-8

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1041020001

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/26852379


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