Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-05-2016 | Trauma Surgery

Anterior augmentation plating of aseptic humeral shaft nonunions after intramedullary nailing

Authors: Jan Gessmann, Matthias Königshausen, Marlon Osman Coulibaly, Thomas Armin Schildhauer, Dominik Seybold

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 5/2016

Abstract

Introduction

Humeral shaft nonunion after intramedullary nailing is a rare but serious complication. Treatment options include implant removal, open plating, exchange nailing and external fixation. The objective of this retrospective study was to determine whether augmentation plating without nail removal is feasible for treating a humeral shaft nonunion.

Materials and methods

Between 2002 and 2014, 37 patients (mean age 51, range 20–84 years) with aseptic humeral shaft nonunions prior to intramedullary nailing were treated with augmentation plating. The initial fractures had been fixed with retrograde nails (10 cases) or anterograde nails (27 cases). There were 34 atrophic nonunions and 3 hypertrophic nonunions. Nonunion treatment of all patients consisted of local debridement through an anterior approach to the humerus and anterior placement of the augmentation plates. Supplemental bone grafting was performed in all atrophic nonunion cases. All patients were followed until union was radiologically confirmed.

Results

Union was achieved in 36 patients (97 %) after a mean of 6 months (range 3–24 months). There was one case of iatrogenic median nerve palsy that showed complete spontaneous recovery 6 weeks postoperatively. One patient sustained a peri-implant stress fracture that was treated successfully by exchanging the augmentation plate to bridge the nonunion and the fracture. No infections or wound healing complications developed. At a mean follow-up of 14 months, all patients showed free shoulder and elbow motion and no restrictions in daily or working life.

Conclusions

The results indicate that augmentation plating using an anterior approach is a safe and reliable option for humeral shaft nonunions after failed nailing, and the treatment has no substantial complications. Because the healing rates are similar to the standard technique of nail removal and fixation by compression or locking plates, we consider this technique to be an alternative choice for treatment.

Ouyang H, Xiong J, Xiang P, Cui Z, Chen L, Yu B (2013) Plate versus intramedullary nail fixation in the treatment of humeral shaft fractures: an updated meta-analysis. J Shoulder Elbow Surg 22(3):387–395. doi:10.1016/j.jse.2012.06.007 (S1058-2746(12)00270-4 [pii]) CrossRefPubMed

Kurup H, Hossain M, Andrew JG (2011) Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures in adults. Cochrane Database Syst Rev 6:CD005959. doi:10.1002/14651858.CD005959.pub2 PubMed

Singh AK, Arun GR, Narsaria N, Srivastava A (2014) Treatment of non-union of humerus diaphyseal fractures: a prospective study comparing interlocking nail and locking compression plate. Arch Orthop Trauma Surg 134(7):947–953. doi:10.1007/s00402-014-1973-0 CrossRefPubMed

Volgas DA, Stannard JP, Alonso JE (2004) Nonunions of the humerus. Clin Orthop Relat Res 419:46–50 (00003086-200402000-00008 [pii]) CrossRefPubMed

McKee MD, Miranda MA, Riemer BL, Blasier RB, Redmond BJ, Sims SH, Waddell JP, Jupiter JB (1996) Management of humeral nonunion after the failure of locking intramedullary nails. J Orthop Trauma 10(7):492–499CrossRefPubMed

Flinkkila T, Ristiniemi J, Hamalainen M (2001) Nonunion after intramedullary nailing of humeral shaft fractures. J Trauma 50(3):540–544CrossRefPubMed

Catagni MA, Guerreschi F, Probe RA (1991) Treatment of humeral nonunions with the Ilizarov technique. Bull Hosp Jt Dis Orthop Inst 51(1):74–83PubMed

Ring D, Jupiter JB, Quintero J, Sanders RA, Marti RK (2000) Atrophic ununited diaphyseal fractures of the humerus with a bony defect: treatment by wave-plate osteosynthesis. J Bone Joint Surg Br 82(6):867–871CrossRefPubMed

Patel VR, Menon DK, Pool RD, Simonis RB (2000) Nonunion of the humerus after failure of surgical treatment. Management using the Ilizarov circular fixator. J Bone Joint Surg Br 82(7):977–983CrossRefPubMed

10.

Kontakis GM, Papadokostakis GM, Alpantaki K, Chlouverakis G, Hadjipavlou AG, Giannoudis PV (2006) Intramedullary nailing for non-union of the humeral diaphysis: a review. Injury 37(10):953–960. doi:10.1016/j.injury.2006.02.050 (S0020-1383(06)00120-3 [pii]) CrossRefPubMed

11.

Gerber A, Marti R, Jupiter J (2003) Surgical management of diaphyseal humeral nonunion after intramedullary nailing: wave-plate fixation and autologous bone grafting without nail removal. J Shoulder Elbow Surg 12(4):309–313. doi:10.1016/mse.2003.S1058274603000442 (S1058274603000442 [pii]) CrossRefPubMed

12.

Roetman B, Scholz N, Muhr G, Mollenhoff G (2008) Augmentive plate fixation in femoral non-unions after intramedullary nailing. Strategy after unsuccessful intramedullary nailing of the femur. Z Orthop Unfall 146(5):586–590. doi:10.1055/s-2008-1038526 PubMed

13.

Birjandinejad A, Ebrahimzadeh MH, Ahmadzadeh-Chabock H (2009) Augmentation plate fixation for the treatment of femoral and tibial nonunion after intramedullary nailing. Orthopedics 32(6):409. doi:10.3928/01477447-20090511-12 (orthopedics.40080 [pii]) CrossRefPubMed

14.

Nadkarni B, Srivastav S, Mittal V, Agarwal S (2008) Use of locking compression plates for long bone nonunions without removing existing intramedullary nail: review of literature and our experience. J Trauma 65(2):482–486. doi:10.1097/TA.0b013e31817c9905 (00005373-200808000-00041 [pii]) CrossRefPubMed

15.

Yang JS, Otero J, McAndrew CM, Ricci WM, Gardner MJ (2013) Can tibial nonunion be predicted at 3 months after intramedullary nailing? J Orthop Trauma 27(11):599–603. doi:10.1097/BOT.0b013e31828f5821 CrossRefPubMedPubMedCentral

16.

Seybold D, Citak M, Konigshausen M, Gessmann J, Schildhauer TA (2011) Combining of small fragment screws and large fragment plates for open reduction and internal fixation of periprosthetic humeral fractures. Int J Shoulder Surg 5(4):105–107. doi:10.4103/0973-6042.91004 CrossRefPubMedPubMedCentral

17.

Hierholzer C, Sama D, Toro JB, Peterson M, Helfet DL (2006) Plate fixation of ununited humeral shaft fractures: effect of type of bone graft on healing. J Bone Joint Surg Am 88(7):1442–1447. doi:10.2106/JBJS.E.00332 (88/7/1442 [pii]) CrossRefPubMed

18.

Blum J, Machemer H, Baumgart F, Schlegel U, Wahl D, Rommens PM (1999) Biomechanical comparison of bending and torsional properties in retrograde intramedullary nailing of humeral shaft fractures. J Orthop Trauma 13(5):344–350CrossRefPubMed

19.

Rosenbaum A, Uhl R (2012) Nonunion of humeral shaft fractures following flexible nailing fixation. Orthopedics 35(6):512–515. doi:10.3928/01477447-20120525-08 CrossRefPubMed

20.

Baltov A, Mihail R, Dian E (2014) Complications after interlocking intramedullary nailing of humeral shaft fractures. Injury 45(Suppl 1):S9–S15. doi:10.1016/j.injury.2013.10.044 CrossRefPubMed

21.

Marti RK, Verheyen CC, Besselaar PP (2002) Humeral shaft nonunion: evaluation of uniform surgical repair in fifty-one patients. J Orthop Trauma 16(2):108–115CrossRefPubMed

22.

Lin CL, Fang CK, Chiu FY, Chen CM, Chen TH (2009) Revision with dynamic compression plate and cancellous bone graft for aseptic nonunion after surgical treatment of humeral shaft fracture. J Trauma 67(6):1393–1396. doi:10.1097/TA.0b013e31818c1595 (00005373-200912000-00043 [pii]) CrossRefPubMed

23.

Lin J, Chiang H, Hou SM (2003) Open exchange locked nailing in humeral nonunions after intramedullary nailing. Clin Orthop Relat Res 411:260–268. doi:10.1097/01.blo.0000069898.31220.9e CrossRefPubMed

24.

Apard T, Ducellier F, Hubert L, Talha A, Cronier P, Bizot P (2010) Isolated interfragmentary compression for nonunion of humeral shaft fractures initially treated by nailing: a preliminary report of seven cases. Injury 41(12):1262–1265. doi:10.1016/j.injury.2010.05.023 (S0020-1383(10)00319-0 [pii]) CrossRefPubMed

25.

Raschke M, Khodadadyan C, Maitino PD, Hoffmann R, Sudkamp NP (1998) Nonunion of the humerus following intramedullary nailing treated by Ilizarov hybrid fixation. J Orthop Trauma 12(2):138–141CrossRefPubMed

26.

Tomic S, Bumbasirevic M, Lesic A, Mitkovic M, Atkinson HD (2007) Ilizarov frame fixation without bone graft for atrophic humeral shaft nonunion: 28 patients with a minimum 2-year follow-up. J Orthop Trauma 21(8):549–556. doi:10.1097/BOT.0b013e31814612c8 (00005131-200709000-00006 [pii]) CrossRefPubMed

27.

Menon DK, Dougall TW, Pool RD, Simonis RB (2002) Augmentative Ilizarov external fixation after failure of diaphyseal union with intramedullary nailing. J Orthop Trauma 16(7):491–497CrossRefPubMed

28.

Ueng SW, Chao EK, Lee SS, Shih CH (1997) Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma 43(4):640–644CrossRefPubMed

29.

Choi YS, Kim KS (2005) Plate augmentation leaving the nail in situ and bone grafting for non-union of femoral shaft fractures. Int Orthop 29(5):287–290. doi:10.1007/s00264-005-0668-0 CrossRefPubMedPubMedCentral

30.

Wu CC, Shih CH, Chen WJ, Tai CL (1998) Staple augmentation to treat a humeral nonunion after failed Seidel locked nailing. Arch Orthop Trauma Surg 118(1–2):42–44CrossRefPubMed

31.

Kontakis GM, Tosounidis T, Pagkalos J (2007) Humeral diaphyseal aseptic non-unions: an algorithm of management. Injury 38(Suppl 2):S39–S49 (doi:S0020-1383(07)80008-8 [pii]) CrossRefPubMed

32.

Rubel IF, Kloen P, Campbell D, Schwartz M, Liew A, Myers E, Helfet DL (2002) Open reduction and internal fixation of humeral nonunions: a biomechanical and clinical study. J Bone Joint Surg Am 84-A(8):1315–1322PubMed

33.

Cadet ER, Yin B, Schulz B, Ahmad CS, Rosenwasser MP (2013) Proximal humerus and humeral shaft nonunions. J Am Acad Orthop Surg 21(9):538–547. doi:10.5435/JAAOS-21-09-538 (21/9/538 [pii]) PubMed

34.

Livani B, Belangero W, Medina G, Pimenta C, Zogaib R, Mongon M (2010) Anterior plating as a surgical alternative in the treatment of humeral shaft non-union. Int Orthop 34(7):1025–1031. doi:10.1007/s00264-009-0863-5 CrossRefPubMedPubMedCentral

35.

Martinez AA, Cuenca J, Herrera A (2009) Two-plate fixation for humeral shaft non-unions. J Orthop Surg (Hong Kong) 17(2):135–138

36.

Willis MP, Brooks JP, Badman BL, Gaines RJ, Mighell MA, Sanders RW (2013) Treatment of atrophic diaphyseal humeral nonunions with compressive locked plating and augmented with an intramedullary strut allograft. J Orthop Trauma 27(2):77–81. doi:10.1097/BOT.0b013e31825360fa CrossRefPubMed

37.

Hornicek FJ, Zych GA, Hutson JJ, Malinin TI (2001) Salvage of humeral nonunions with onlay bone plate allograft augmentation. Clin Orthop Relat Res 386:203–209CrossRefPubMed

38.

Leibner ED, Mosheiff R, Safran O, Abu-Snieneh K, Liebergall M (1999) Femoral fracture at the proximal end of an intramedullary supracondylar nail: a case report. Am J Orthop (Belle Mead NJ) 28(1):53–55

39.

Harris T, Ruth JT, Szivek J, Haywood B (2003) The effect of implant overlap on the mechanical properties of the femur. J Trauma 54(5):930–935. doi:10.1097/01.TA.0000060999.54287.39 CrossRefPubMed

40.

Kim HK, Noh KC, Chung KJ, Hwang JH (2012) Use of Huckstep nail in the periimplant femoral shaft fracture. Indian J Orthop 46(6):718–720. doi:10.4103/0019-5413.104240 CrossRefPubMedPubMedCentral

41.

Ring D, Jupiter J (2003) Humerus nonunion after intramedullary rod fixation. Tech Orthop 18(4):356–359CrossRef

42.

Wright TW (1997) Treatment of humeral diaphyseal nonunions in patients with severely compromised bone. J South Orthop Assoc 6(1):1–7PubMed

43.

Murena L, Canton G, Vulcano E, Surace MF, Cherubino P (2014) Treatment of humeral shaft aseptic nonunions in elderly patients with opposite structural allograft, BMP-7, and mesenchymal stem cells. Orthopedics 37(2):e201–e206. doi:10.3928/01477447-20140124-26 CrossRefPubMed

Title: Anterior augmentation plating of aseptic humeral shaft nonunions after intramedullary nailing
Authors: Jan Gessmann
Matthias Königshausen
Marlon Osman Coulibaly
Thomas Armin Schildhauer
Dominik Seybold
Publication date: 01-05-2016
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 5/2016
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-016-2418-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Anterior augmentation plating of aseptic humeral shaft nonunions after intramedullary nailing

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2016

Cobalt serum levels differ in well functioning Birmingham resurfacing and Birmingham modular THA

Current status of ACL reconstruction in Germany

Pre-operative templating in total elbow arthroplasty: not useful

Measuring long radiographs affects the positioning of femoral components in total knee arthroplasty: a randomized controlled trial

Are porcine flexor digitorum profundus tendons suitable graft substitutes for human hamstring tendons in biomechanical in vitro-studies?

Bilateral sternoclavicular joint dislocation due to sternal fracture: Is it a dislocation or a separation?