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Treatment of Atrophic Diaphyseal Humeral Nonunions With Compressive Locked Plating and Augmented With an Intramedullary Strut Allograft.
MedLine Citation:
PMID:  22668548     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE:: The aim of this study was to evaluate the effectiveness of thorough debridement and locked compression plating augmented with an intramedullary fibular allograft for the treatment of atrophic diaphyseal humeral nonunions. DESIGN:: The study involved a level 4 retrospective case series. SETTING:: This study was conducted at a level 1 university trauma center. PATIENTS:: Twenty patients with painful atrophic nonunions of the humeral diaphysis were examined. INTERVENTION:: This involved a thorough debridement and locked compression plating augmented with an intramedullary fibular allograft. MAIN OUTCOME MEASURES:: These were union rate, shoulder range of motion, visual analog scale (VAS) pain, VAS function, patient satisfaction, and American Shoulder and Elbow Surgeons score at latest follow-up. METHODS:: Clinical and radiographic examinations were performed preoperatively and postoperatively. VAS pain and function scores were collected preoperatively and postoperatively. Patient satisfaction and ASES scores were recorded at the time of the most recent follow-up. RESULTS:: Bony union was achieved in 19 of 20 patients (95%). The patients demonstrated an average improvement in forward elevation from 65 to 144° (P = 0.001), abduction from 48 to 133° (P < 0.001), external rotation from 34 to 70° (P = 0.05), and internal rotation from S1 to T12 (P = 0.025). VAS pain scores improved from 6.05 to 1.88 (P = 0.032). VAS function scores improved from 2.06 to 7.75 (P = 0.003). The average postoperative ASES score was 76, and the average patient satisfaction was rated 9.3/10. CONCLUSIONS:: Atrophic nonunions of the humerus can be successfully treated with debridement of the nonunion, coupled with the use of a fibular allograft and locked compression plating. This technique leads to predictable healing without the morbidity associated with autograft.
Authors:
Matthew P Willis; Jordan P Brooks; Brian L Badman; Robert J Gaines; Mark A Mighell; Roy W Sanders
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-4
Journal Detail:
Title:  Journal of orthopaedic trauma     Volume:  -     ISSN:  1531-2291     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8807705     Medline TA:  J Orthop Trauma     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
*Department of Shoulder and Elbow Surgery, Florida Orthopaedic Institute, Tampa, FL †Department of Clinical Research, Foundation for Orthopaedic Research and Education, Tampa, FL.
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