Open reduction and internal fixation for humeral diaphyseal nonunion tied to high rate of union
Open reduction and internal fixation (ORIF) for humeral diaphyseal nonunion was associated with a high rate of union and routine bone grafting was not required and avoided the risk of donor site morbidity, reports a study.
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.