Étude rétrospective des résultats du traitement chirurgical de 21 pseudarthroses de l'humérus

Continuous external compression for the treatment of humeral pseudarthrosis: a single center experience

Humeral pseudarthrosis are common with a non-union rate after fracture between 8% and 13%. Several operative methods have been described for the treatment of humeral pseudarthrosis. The aim of this study was to assess a new approach based on compression using a monoplane external fixator without graft. This study was conducted in the Department of Orthopedic Surgery, and Traumatology of Habib Bourguiba University Hospital in Sfax-Tunisia between April 2009 and September 2018. Fifty-eight patients were operated on using a dynamic monoplane axial fixation device with continuous compression by manipulating the compression system of the fixator. All the cases were evaluated according to the modified Stewart and Hundley classification. The fracture was located in the middle third in 53.4% of the cases. The pseudarthrosis was hypertrophic in 34.5% of the cases. Fifty-four patients were treated with this method as a first cure of non-union and four patients had previously a first cure for their pseudarthrosis. We noted 11 septic pseudarthrosis. The average follow-up was 47.2 months. We obtained consolidation in 98% of the cases. The average consolidation time was 5.1 months. Based on the modified Stewart and Hundley criteria, 75.8% had very good results. This study highlights that a continuous external compression is effective in the treatment of non-unions, as it allows consolidation without opening the pseudarthrosis site and without bone grafting while having satisfactory anatomical and functional results.

[Aseptic non-union of humeral shaft fractures treated by plating and bone grafting. Report of 20 cases]

Although aseptic non-union of humeral shaft fractures is generally considered to be an exceptional complication, rates in the literature have varied from 1 to 10%. The aim of this retrospective study was to study the results of treatment by plating and bone grafting for aseptic non-union of humeral shaft fractures. The retrospective study gathered 20 patients, the mean age was 41 years. The most common fracture site was the middle third. For the follow-up evaluation, we used the Steward and Hundley score. According to this score, we noted: 13 very good results, five good results and two poor results. Management of non-union of the humerus should be optimal at immediate surgery. The best treatment of non-union of the humerus is its prevention by correct management of the initial fracture.

Isolated interfragmentary compression for nonunion of humeral shaft fractures initially treated by nailing: A preliminary report of seven cases

INTRODUCTION

Plating with bone grafting is considered the gold standard treatment for nonunion of humeral shaft fractures. However, this complex procedure involves multiple risks. The aim of this study is to evaluate an alternative treatment using isolated axial interfragmentary compression for the dynamisation of humeral shaft nonunion after retrograde locked nailing.

MATERIALS AND METHODS

Between January 2000 and May 2009, 124 humeral shaft fractures were treated in our trauma department with retrograde locked nailing using the unreamed humeral nail (UHN(®), Synthes, Paoli, PA, USA). Nonunion occurred in seven patients (5.6%) - five females and two males, mean age 44 years (range: 17-73 years). The nonunion was treated by applying isolated secondary interfragmentary compression. Mean follow-up was 43 months (range: 8-74 months). The Rommens score and the disabilities of the arm, shoulder and hand (DASH) score were used to evaluate the global functioning of the upper limb.

RESULTS

The compression procedure was successful in all seven cases. In each case, the union occurred without any complications in 3-5 months. The mean DASH score was 25/100 (range: 8.3-60.8/100). The Rommens score was judged excellent for five of the seven patients but two were rated moderate. One of these suffered from complex regional pain syndrome type II since the fracture, and another developed a stiff shoulder 6 months after trauma.

CONCLUSION

Isolated secondary interfragmentary compression appears to be a simple and successful procedure in cases of humeral nonunion.