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Massin V, Laumonerie P, Bonnevialle N, Le Baron M, Ollivier M, Flecher X, Argenson JN, Lami D. What treatment for humeral shaft non-union? Case-series assessment of a strategy. Orthop Traumatol Surg Res 2023; 109:103532. [PMID: 36572380 DOI: 10.1016/j.otsr.2022.103532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/05/2022] [Accepted: 09/27/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Humeral shaft non-union is frequent, with severe clinical impact. Management, however, is poorly codified and there is no clear decision-tree. HYPOTHESIS Analyzing our experience over the last 15years could enable a reproducible strategy to be drawn up, with a decision-tree based on the 2 main causes: failure of internal fixation, and infection. MATERIAL AND METHOD Sixty-one patients were included in a retrospective cohort, with a mean 94 months' follow-p. The treatment strategy was based on screening first for infection then for mechanical stability deficit in case of prior internal fixation. Any fixation revision was associated to cancellous autograft. In case of suspected or proven infection, 2-stage treatment was implemented. In case of primary non-operative treatment, the strategy was based on the non-union risk on the Non-Union Scoring System (NUSS), with internal fixation and possible graft. RESULTS There were 6 failures, for a consolidation rate of 90%; excluding patients not managed according to the study protocol, the consolidation rate was 95%. There was 1 case of spontaneously resolving postoperative radial palsy, and 3 patients required surgical revision. DISCUSSION The present strategy achieved consolidation in most cases, providing the surgeon with a decision-tree for these patients. Infectious etiologies are often overlooked and should be a focus of screening. LEVEL OF EVIDENCE IV, retrospective or historical series.
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Affiliation(s)
- Valentin Massin
- Service de chirurgie orthopédique, Hôpital Nord, Pôle Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Institut du Mouvement et de l'Appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
| | - Pierre Laumonerie
- Service de chirurgie orthopédique, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Nicolas Bonnevialle
- Service de chirurgie orthopédique, Hôpital Pierre Paul Riquet, CHU de Toulouse, Toulouse, France
| | - Marie Le Baron
- Service de chirurgie orthopédique, Hôpital Nord, Pôle Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Institut du Mouvement et de l'Appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Matthieu Ollivier
- Institut du Mouvement et de l'Appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Service de chirurgie orthopédique, Hôpital Sainte-Marguerite, Pôle Locomoteur, Assistance-Publique Hôpitaux de Marseille, Marseille, France
| | - Xavier Flecher
- Service de chirurgie orthopédique, Hôpital Nord, Pôle Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Institut du Mouvement et de l'Appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Jean-Noël Argenson
- Institut du Mouvement et de l'Appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Service de chirurgie orthopédique, Hôpital Sainte-Marguerite, Pôle Locomoteur, Assistance-Publique Hôpitaux de Marseille, Marseille, France
| | - Damien Lami
- Institut du Mouvement et de l'Appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Service de chirurgie orthopédique, Hôpital Sainte-Marguerite, Pôle Locomoteur, Assistance-Publique Hôpitaux de Marseille, Marseille, France
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