Document Detail

A case series and review of salvage surgery for refractory humeral shaft nonunion following two or more prior surgical procedures.
MedLine Citation:
PMID:  16089097     Owner:  NLM     Status:  MEDLINE    
The orthopedic surgery literature is replete with techniques for managing primary humeral shaft nonunions, with success rates upwards of 90 percent with plate fixation and autogenous bone grafting. Despite this success, persistent nonunion following one or more initial failed nonunion interventions can occur, imposing a significant clinical and surgical challenge. We report the application of a standard treatment protocol for refractory humeral shaft nonunions including optimization of patient co-morbidities in the peri-operative period, rigid 4.5mm compression plating with a minimum of eight cortices of fixation proximal and distal to the nonunion site, and utilization of autogenous bone grafting. This study, a retrospective review of seven patients, all managed based on this standard treatment protocol, revealed that all achieved fracture nonunion within six months of revision surgery. Six of seven patients were clinically satisfied with the outcome of surgery; one remained dissatisfied secondary to a chronic neuropathic pain syndrome. Although more complex surgical options such as Ilizarov external fixation and allograft cortical strut augmentation have been reported, and are available in the salvage situation of refractory humeral nonunions, we conclude strict application of basic nonunion principles can result in successful salvage of humerus nonunions in patients who have failed two or more prior surgical interventions.
Todd A Borus; Edward H Yian; Madhav A Karunakar
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Iowa orthopaedic journal     Volume:  25     ISSN:  1541-5457     ISO Abbreviation:  Iowa Orthop J     Publication Date:  2005  
Date Detail:
Created Date:  2005-08-10     Completed Date:  2005-10-07     Revised Date:  2013-06-09    
Medline Journal Info:
Nlm Unique ID:  8908272     Medline TA:  Iowa Orthop J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  194-9     Citation Subset:  IM    
Department of Orthopedic Surgery, University of Michigan, 1500 E. Medical Center Drive, TC 2912 G, Ann Arbor, MI 48109-0328, USA.
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MeSH Terms
Bone Plates
Bone Transplantation
Clinical Protocols
Fracture Fixation, Internal*
Fractures, Ununited / surgery*
Humeral Fractures / surgery*
Middle Aged
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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