Open reduction and internal fixation for humeral shaft nonunion: bone grafting is not routinely required and avoids donor site morbidity

William M Oliver, Samuel Molyneux, Timothy O. White, Nicholas D Clement, Andrew Duckworth, John F. Keating

Research output: Contribution to journalArticlepeer-review

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.
Original languageEnglish
JournalJournal of Orthopaedic Trauma
Early online date1 Aug 2021
DOIs
Publication statusE-pub ahead of print - 1 Aug 2021

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