Treatment of nonunion around the olecranon fossa of the humerus by intramedullary locked nailing

Treatment of supracondylar humeral non-union by bone autograft and Hoffmann II external fixation

Supracondylar humeral nonunions are difficult to heal by internal fixation. Prosthetic arthroplasty is a solution in elderly patients. Both therapeutic options are contraindicated in the case of an infection. The article reports bone autografting and Hoffmann humero-humeral and temporary humero-ulnar Hoffmann external fixation. In our series of seven cases, there was only one minor complication, a benign pin-site infection. There were neither neurovascular complication nor loss of reduction. Solid bone healing was obtained in all patients after an average of 5.2 months (range, 2.5 to 6 months). External fixation is a form of "biologic" fixation, as there is no implant apposed on the bone fragments, preventing their revascularization. This easy technique allows to correct the preoperative deformity while providing sufficient stability to allow active mobilization. Temporary elbow bridging does not seem to cause significant stiffening of the joint.

Comparison of three different treatment modalities in the management of humeral shaft nonunions (plates, unilateral, and circular external fixators)

OBJECTIVES

To compare 3 different fixation methods for the treatment of humeral shaft nonunions in terms of union time, functional outcome, and complications.

DESIGN

Retrospective case series.

SETTING

University hospital.

PATIENTS

Between 1996 and 2004, 80 patients (mean age, 49; range, 15 to 86; 30 women and 50 men) with nonunions of the humeral shaft were treated surgically in our institution. Circular external fixators (CEF) were used in 35 patients, unilateral limb reconstruction system (LRS) fixators in 24 patients and fixation with plates in 21 patients.

INTERVENTION

Surgical procedure included hardware removal in previously operated patients, autogenous grafting in all patients in the plate group and in those patients with atrophic nonunions in the external fixator groups, compression of the nonunion site in all patients.

MAIN OUTCOME MEASUREMENTS

Radiological union time, complications, shortening, and disabilities of the arm, shoulder, and hand (DASH) score.

RESULTS

Mean follow-up period was 48.1 months (range, 12 to 121). Mean radiological union time was 5.5 months (range, 1.5 to 12) in the CEF group, 5.2 months (range, 3 to 10) in the LRS group, and 5.7 months (range, 3 to 12) in the plate group. Mean DASH score was 23.7 in the CEF group, 18.6 in the LRS group, and 26 in the plate group. There were no statistical differences in terms of union time and the DASH score among the 3 groups. Successful union was achieved in 77 (96.3%) patients.

CONCLUSION

Both external fixation and plate fixation produce excellent results in humeral shaft nonunions if applied properly. The procedure can be tailored to the surgeon's experience, keeping in mind that plate fixation demonstrates a longer healing time in those cases that had previous surgeries.