| Objective:Humerus is one of long bone in the upper extremities.Along with the ever fast development of modern transportation and the change of production method in life style,more and more humeral fractures occur due to high-energy lesion.Although modern medical level enhances unceasingly,humeral nonunion is still a great challenge for orthopedic surgeons.In this study,we analyzed the cases of humeral nonunion after surgery by retrospective analysis.The causes of bone nonunion and the therapeutic effects of the plate fixation have been explored,attempting to guide clinical work.Methods:The cases are collected from hospitalized patients with humeral nonunion of Department of Trauma Orthopedics,Xi Jing Hospital,the Forth Military Medical University since February 2010 to September 2015.32 patients were involved in this study,among whom 4 people were lost to follow-up.Of the 28 available cases,17 were male,while 11 were female.The average age was 40.1±11.3,ranging from 20 to 75.The average time span from the first operation to visiting our department was 16.2 months,ranging from 9 months to 32 months.Times for operation before hospitalizing: 18 cases for once,7 cases for twice,3 cases for three times.Initial injury: 23 cases for closed injury,5 cases for open injury.The original fixed method: 2 cases for intramedullary nail fix(7.1%),15 cases for steel screws fix(53.6%),5 cases for external fix(17.9%),6 cases for steel wire and plate fixation(21.4%).Nonunion type: Hyperplasia nonunion 14 cases,malnutrition nonunion 3 cases,atrophic nonunion 11 cases,Bone nonunion site: 1 cases for humeral upper-middle segment,17 cases for humeral middle segment,10 cases for humeral lower-middle segment.Initial injury reason: 16 cases for car accident,3 cases for bruise injury caused by heavy object,4 cases for falling down from high,5 cases for tumble.Initial fractures AO type: type A in 11 cases,9 cases for B type,type C in 8 cases.Open reduction and internal fixation by plate was used in all cases.Bone grafting was performed with different method by circumstance.5 cases were treated with ICBG,12 cases were treated with RBX combined ICBG.11 cases treated by RBX.Proper rehabilitation exercise was performed step by step with guidance of surgery.Results:All 28 cases received follow-up,ranging from 10 months to 6 years,an average of 16.5 months.The total healing rate was 92.9%(26/28),postoperative function excellent and good rate was 85.7% by shoulder score,and 92.3% by elbow score.Humeral shaft nonunion treated with open reduction and internal fixation by plate combined with proper bone graft resulted in good healing rate and postoperative function.In addition,LCP combined with ICBG and RBX is an effective method to improve union rate of non-infective atrophic humeral shaft nonunion.Conclusion:Violent damage,improper postoperative functional exercise and iatrogenic factors such as improper operation,improperly choice of internal fixation are the main reasons for infective humeral nonunion.Plate fixation is still a proper treatment for humeral shaft fracture,which should focus on ensuring strong fixation,avoiding stress shelter,thorough debridement,protecting the blood supply,preventing infection and so on.Finally,the effective bone graft,as well as reasonable postoperative function exercise should not be neglected. |
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