Abstract / Description of output
Objectives: To document union rate, complications and patient-reported outcomes following open reduction and internal fixation (ORIF), with and without bone grafting (BG), for humeral diaphyseal nonunion following failed non-operative management.
Design: Retrospective.
Setting: University teaching hospital.
Patients and intervention: From 2008-2017, 86 consecutive patients (mean age 59 years [range 17-86], 71% [n=61/86] female) underwent nonunion ORIF (plate and screws) at a mean of 7 months post-injury (range 3-21.5). Eleven (13%) underwent supplementary BG.
Main outcome measurements: Union rate and complications for 83 patients (97%) at a mean of 10 months (3-61). Patient-reported outcomes (QuickDASH, EQ-5D, EQ-VAS, SF-12, satisfaction) for 53 living, cognitively-intact patients (78%) at a mean of 4.9 years (0.3-9.2).
Results: Ninety-three percent (n=77/83) achieved union following nonunion ORIF. Complications included recalcitrant nonunion (7%, n=6/83), iatrogenic radial nerve palsy (6%, n=5/83), infection (superficial 7%, n=6/83; deep 2%, n=2/83) and iliac crest donor site morbidity (38%, n=3/8). The union rate with BG was 78% (n=7/9) and without was 95% (n=70/74; p=0.125), and was not associated with nonunion type (atrophic 91%, n=53/58; hypertrophic 96%, n=24/25; p=0.663). Median QuickDASH was 22.7 (0-95), EQ-5D 0.710 (-0.181-1), EQ-VAS 80 (10-100), SF-12 PCS 41.9 (16-60.5) and MCS 52.6 (18.7-67.7). Nineteen percent (n=10/53) were dissatisfied with their outcome.
Conclusions: ORIF for humeral diaphyseal nonunion was associated with a high rate of union. Routine BG was not required and avoided the risk of donor site morbidity. One in five patients were dissatisfied despite the majority achieving union.
Design: Retrospective.
Setting: University teaching hospital.
Patients and intervention: From 2008-2017, 86 consecutive patients (mean age 59 years [range 17-86], 71% [n=61/86] female) underwent nonunion ORIF (plate and screws) at a mean of 7 months post-injury (range 3-21.5). Eleven (13%) underwent supplementary BG.
Main outcome measurements: Union rate and complications for 83 patients (97%) at a mean of 10 months (3-61). Patient-reported outcomes (QuickDASH, EQ-5D, EQ-VAS, SF-12, satisfaction) for 53 living, cognitively-intact patients (78%) at a mean of 4.9 years (0.3-9.2).
Results: Ninety-three percent (n=77/83) achieved union following nonunion ORIF. Complications included recalcitrant nonunion (7%, n=6/83), iatrogenic radial nerve palsy (6%, n=5/83), infection (superficial 7%, n=6/83; deep 2%, n=2/83) and iliac crest donor site morbidity (38%, n=3/8). The union rate with BG was 78% (n=7/9) and without was 95% (n=70/74; p=0.125), and was not associated with nonunion type (atrophic 91%, n=53/58; hypertrophic 96%, n=24/25; p=0.663). Median QuickDASH was 22.7 (0-95), EQ-5D 0.710 (-0.181-1), EQ-VAS 80 (10-100), SF-12 PCS 41.9 (16-60.5) and MCS 52.6 (18.7-67.7). Nineteen percent (n=10/53) were dissatisfied with their outcome.
Conclusions: ORIF for humeral diaphyseal nonunion was associated with a high rate of union. Routine BG was not required and avoided the risk of donor site morbidity. One in five patients were dissatisfied despite the majority achieving union.
Original language | English |
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Journal | Journal of Orthopaedic Trauma |
Early online date | 1 Aug 2021 |
DOIs | |
Publication status | E-pub ahead of print - 1 Aug 2021 |