Open reduction and internal fixation for humeral diaphyseal nonunion tied to high rate of union

The study is published in the Journal of Orthopaedic Trauma.

Oliver, William M. et al from the Edinburgh Orthopaedics – Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom carried out the present study with the objective to document union rate, complications and patient-reported outcomes after open reduction and internal fixation (ORIF), with and without bone grafting (BG), for humeral diaphyseal nonunion after failed nonoperative management.

The authors conducted a retrospective study with 86 consecutive patients with a mean age 59 years (range 17–86), out of which 71% (n = 61/86) comprised of women. All underwent nonunion open reduction and internal fixation (plate and screws) at a mean of 7 months post injury (range 3–21.5). Eleven (13%) underwent supplementary bone grating procedure.

The study outcomes were established as union rate and complications for 83 patients (97%) at a mean of 10 months (3–61). Patient-reported outcomes for 53 living, cognitively-intact patients (78%) were at a mean of 4.9 years (0.3–9.2).

It was observed that ninety-three percent (n = 77/83) achieved union after nonunion open reduction and internal fixation. 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).

Moreover, the union rate with bone grafting was 78% (n = 7/9) and without was 95% (n = 70/74; P = 0.125), and was not associated with the nonunion type (atrophic 91%, n = 53/58; hypertrophic 96%, n = 24/25; P = 0.663).

Furthermore, the median QuickDASH was 22.7 (0–95), EQ-5D 0.710 (−0.181-1), EQ-visual analog scale 80 (10–100), SF-12 physical component summary 41.9 (16–60.5), and mental component summary 52.6 (18.7–67.7). On the whole, nineteen percent (n = 10/53) were dissatisfied with their outcome.

Therefore, it was concluded that open reduction and internal fixation for humeral diaphyseal nonunion was associated with a high rate of union. Routine bone grafting was not required and avoided the risk of donor site morbidity. One in 5 patients were dissatisfied despite the majority achieving union.

10.1097/BOT.0000000000002032