- See:
Non Union - General Discussion:
- Discussion:
- care must be taken not to mistake a pseudoarthrosis for a simple hypertrophic nonunion;
- treatment of the pseudoarthrosis requires complete resection of the synovial tissue, and a closed IM nail does not suffice;
-
bone scan is helpful in diagnosis of pseudoarthrosis, which appears as a cold cleft between hot ends;
- if bone ends appear avascular, the bone grafting is a necessity;
- Proximal Humeral Non Union:
Inital Frx Non Union Rigid Fixation
- references:
Nonunion of the proximal humerus. A review of 25 cases.
Blade plate fixation of proximal humeral non-unions.
- Humeral Shaft Non Union:
- risk factors:
- open fracture
- segmental, transverse, or highly comminuted
fracture pattern;
- significant displacement of the fracture
fragments (>100% of the shaft diameter);
- smoking, diabetes, nonsteroidal
anti-inflammatory drugs
-
infection (at the time of surgical revision, multiple cultures from the fracture site are required to rule out infection);
- hypothyroidism,
metabolic bone disease
-
management:
- usually involves
plate fixation as exchange
IM nailing gives poor results;
- references:
-
Treatment of humeral shaft nonunions: nailing versus plating.
-
Failure of reamed nailing in humeral non-union: an analysis of 26 patients.
-
Locked intramedullary nailing for difficult nonunions of the humeral diaphysis.
- references:
The treatment of nonunions and pseudarthroses of the humeral shaft.
Internal fixation of frx and non-unions of the humeral shaft. Indications and results in a multi-center study.
Nonunion of the humerus. Clinical, xray, scintigraphic, and response characteristics to treatment with constant
direct current stimulation of osteogenesis.
The management of nonunions of the humerus. Corley FG. Instructional Course Lectures. 39:277-88, 1990.
Internal fixation of fractures and non-unions of the humeral shaft: Indications and results in a multi-center study.
RJ Foster, GL Dixon, AW Bach, RW Appleyard, TM Green. JBJS 67-A, 1985. p 857-864.
Complex non-union of the humeral diaphysis. Treatment with a medial approach, an anterior plate, and a vascularized fibular graft
Nonunion of the humeral shaft.
Nonunion of the humerus.
A combined therapeutic protocol for aseptic nonunion of the humeral shaft: a report of 25 cases.
Nonunion of the Humeral Shaft: Long Lateral Butterfly Fracture-A Nonunion Predictive Pattern?
Shortening osteotomy and compression plating for atrophic humeral nonunions: surgical technique
Distal Humeral Non Union:
- nonunion of fractures of the distal humerus usually occurs when stable
internal fixation has not been achieved;
- references:
Open reduction and internal fixation of delayed union and nonunion of the distal humerus.
Reconstruction after malunion and nonunion of intra-articular fractures of the distal humerus. Methods and results in 13 adults.
Non-union of fractures of the distal end of the humerus.
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