Proximal Humeral Nonunions Treated With Fixed-Angle Locked Plating and an Intramedullary Strut Allograft

Badman, Brian L.; Mighell, Mark A.; Kalandiak, Steven P.; Prasarn, Mark L.

doi:10.1097/bot.0b013e31819b0bdc

Cited by 60 publications

(30 citation statements)

References 29 publications

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“…The nailing procedure may cause a mechanical impingement and usually requires a second procedure to remove the rods [9,10,11]. Shoulder arthroplasty is only indicated in selected old patients or as a salvage procedure because it is important to preserve the native humeral head in young patients with relatively good bone stock [3,5,7,12]. The most viable fixation technique at present involves using an angle-stable device.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Surgical Neck Nonunions of the Humerus with Locked Plate and Autologous Fibular Strut Graft

Gao¹,

Gao²,

Huang³

et al. 2012

Med Princ Pract

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Objectives: To determine whether using a fixed-angle locked plate plus a fibular strut autograft to treat humeral surgical neck nonunions can result in improved union. Patients and Methods: The study cohort included 5 females and 2 males with an average age of 58.4 years (range 45–76) who presented with atrophic nonunion of the surgical neck of the humerus. All patients underwent revision surgery with locked plating plus a nonvascularized autologous fibular strut bone graft. Clinical and radiological union was documented in all patients. Results: The mean time from initial trauma to last revision surgery was 20.1 ± 12.6 months (range 12–48). The average time between revision surgery and the date of union was 6.1 months (range 5–8). The average active forward flexion was 124° (range 70–160) at final follow-up. The Constant-Murley score increased from an average of 25.7 points preoperatively to 77.7 points postoperatively (p < 0.001). The average analog scale of pain decreased from 7.57 points (range 6–10) preoperatively to 0.57 points (range 0–2) postoperatively (p < 0.001). Conclusions: Locked plate fixation and autologous fibular strut bone graft facilitated the successful treatment of humeral surgical neck nonunions.

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Section: Discussionmentioning

confidence: 99%

Treatment of Surgical Neck Nonunions of the Humerus with Locked Plate and Autologous Fibular Strut Graft

Gao¹,

Gao²,

Huang³

et al. 2012

Med Princ Pract

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show abstract

“…The replacement in such cases is described, but reported results are not good 34. Attempts continue to achieve healing in these rather complex cases 7–9…”

Section: Discussionmentioning

confidence: 99%

Pseudarthrosis of the surgical neck of humerus treated by buttressing with a medial cortico-cancellous graft

Maheshwari

Pandey²

2012

IJOO

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Background:Pseudarthrosis of surgical neck of humerus is uncommon condition. Different methods of improving the stability of fixation have been described, including impaling the shaft into the head, placing a tension suture through the rotator cuff, or using an intramedullary cortical graft. We report our results of cortico-cancellous strut graft medially to counter the varus force, in conjunction with a fixed-angle implant on the lateral side.Materials and Methods:We used this technique in seven cases of pseudarthrosis of surgical neck of the humerus. There were four women and three men, ranging in age from 22 to 65 years. All were treated with a tricortical medial buttress bone graft and fixed-angle fixation device on the lateral side. A locking proximal humerus plate (Synthes) was used in six cases, and a bent reconstruction plate (Synthes) was applied in one case. The one in which reconstruction plate was applied was operated before the advent of locking plates. The limb was immobilized in 30° of abduction over a cushion for 6 weeks, followed by a sling for another 6 weeks.Results:The followup varied from 18 to 96 months. All our cases healed within mean 5.1 months (range 4–6 months). There was one case of avascular necrosis. All cases had useful function of shoulder.Conclusion:The medial buttressing by strut graft with external fixation by laterally placed fixed angle plate is successful to achieve fracture union in pseudarthrosis of surgical neck of humerus.

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“…Uses include treating nonunions in the proximal and diaphysis regions of the humerus as well as in the subtrochanteric region of the femur; following curettage for bone tumors; for femoral neck nonunions; and for periprosthetic fractures at the shoulder, hip, and knee. [4][5][6][7][8][9][10][11][12][13][14][15][16][17] Fibular strut allografts are often used when additional structure is needed and when ingrowth over time is desired. However, its use in a patient with osteoporosis with a distal humerus fracture has not been previously described to our knowledge.…”

Section: Discussionmentioning

confidence: 99%

Use of a Fibular Strut Allograft in an Osteoporotic Distal Humerus Fracture

Hildebrand

Wright

Marston

et al. 2012

Geriatr Orthop Surg Rehabil

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In 2004, nearly 120 000 fragility fractures of the humerus were reported. As the US population ages, this number is expected to increase. Fractures of the distal humerus can be treated in a closed or open fashion. Open treatment includes open reduction and internal fixation or total elbow arthroplasty. Open reduction and internal fixation typically involves dual plating for increased stability and early mobility. We present a case in which dual plating failed due to lack of screw purchase in osteoporotic bone. This patient's fracture was then revised with the use of a fibular strut allograft for improved stability and screw purchase. This method of fixation has not previously been described in the distal humerus and may prove useful in open fixation of osteoporotic distal humerus fractures.

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Proximal Humeral Nonunions Treated With Fixed-Angle Locked Plating and an Intramedullary Strut Allograft

Abstract: Intramedullary strut allograft insertion combined with fixed-angle plating is an effective technique for treating viable nonunions of the proximal humerus and was successful in achieving union in 94% of our patients.

Cited by 60 publications

References 29 publications

Treatment of Surgical Neck Nonunions of the Humerus with Locked Plate and Autologous Fibular Strut Graft

Treatment of Surgical Neck Nonunions of the Humerus with Locked Plate and Autologous Fibular Strut Graft

Pseudarthrosis of the surgical neck of humerus treated by buttressing with a medial cortico-cancellous graft

Use of a Fibular Strut Allograft in an Osteoporotic Distal Humerus Fracture

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