Management of nonunions of the proximal humeral diaphysis.
Academic Article
Overview
abstract
It has been reported that the majority of nonunions of the humeral shaft evaluated are within the proximal one-third of the diaphysis. We are not aware of any reported series of humeral nonunions dealing specifically with the proximal diaphysis. We therefore sought to identify patients with a humeral shaft nonunion from an orthopaedic trauma service database, determine the frequency of those within the proximal one-third and review our treatment strategy and resulting clinical outcomes for these difficult fractures. Clinical and radiographical follow-up was available for 19 patients with a mean age of 70 years (range 29-94 years). This represented 46% of all humeral shaft nonunions treated during the study period. Dual plating was used in 11 cases to get adequate fixation in the proximal segment. Post-operative alignment was within 5° of anatomic in all cases. All nonunions healed at an average of 15.2 weeks (range 8-36 weeks). The mean length of follow-up was 12.5 months (range 6-122 months). All patients reported significant improvement in pain. The mean range of motion following fracture union was forward flexion 137°, external rotation 41° and internal rotation 30°. There were two minor complications and neither required a secondary surgery. The surgical technique we have used emphasising a thorough debridement of the nonunion site, correction of the deformity, fracture site compression with a rigid construct and bone grafting provides excellent rates of union and clinical outcomes.
