EFFECTIVENESS OF LOCKING COMPRESS PLATE FOR TREATMENT OF ASEPTIC DIAPHYSEAL HUMERAL NONUNIONS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIJiantao ¹ , YINPeng ^1,2 , ZHANGHao ³ , ZHANGLihai ¹ , LIANGYutian ¹ , ZHOUJianfeng ¹ , LIChen ^1,2 , CAOYanxiang ¹ , ZHANGHao ¹ ,  TANGPeifu ¹

1. Department of Orthopaedics, General Hospital of Chinese PLA, Beijing, 100853, P. R. China;
2. Medical College, Nankai University;
3. Department of Orthopaedics, the 264th Hospital of Chinese PLA;

Corresponding author：

TANGPeifu, Email: pftang301@sina.cn

Keywords：

Humeral shaft fracture; Aseptic bone nonunion; Locking compress plate; Effectiveness

DOI：

10.7507/1002-1892.20150267

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Objective To evaluate the effectiveness of locking compress plate (LCP) for the treatment of aseptic diaphyseal humeral nonunions. Methods Between January 2006 and January 2012, 23 patients with aseptic diaphyseal humeral nonuninons were treated with LCP and autologous iliac crest bone graft, and the clinical data were retrospectively analyzed. There were 15 males and 8 females with the average age of 42.5 years (range, 28-60 years). The fracture located at left side in 11 cases and right side in 12 cases. The mechanism of the injury was traffic accident in 15 patients, and falling from height in 8 patients. Fracture was treated by internal fixation in 20 cases and external fixation in 3 cases. And 6 patients had open fractures and other 17 had close fractures. Based on the Weber-Cech classification, 6 cases were rated as atrophic nonunions, and 17 cases as hypertrophic nonuninons. Shoulder function was evaluated by Constant-Murley score and elbow function was evaluated by Mayo score. Results After operation, 2 patients had transient radial nerve symptoms of numbness and 1 patient had superficial infection. Primary healing of incision was obtained in the other patients. All patients were followed up 22.22 months on average (range, 16-30 months). Normal range of motion of the shoulder was found in 11 cases; and limited movements of abduction, elevation, and posterior extension were observed in 12 cases. And osseous union was observed clinically and radiographically in all patients. The average union time was 16.95 weeks (range, 12-24 weeks). The average Constant-Murley score was 81.87 (range, 50-98); and shoulder function was excellent in 14 cases, good in 6, and fair in 3. And the average Mayo score was 87.78 (range, 70-96); and the result was excellent in 14 cases, good in 7, and fair in 2. Conclusion Aseptic diaphyseal humeral nonunions can be successfully treated with LCP, coupled with the use of autologous iliac crest bone graft.

Citation： LIJiantao, YINPeng, ZHANGHao, ZHANGLihai, LIANGYutian, ZHOUJianfeng, LIChen, CAOYanxiang, ZHANGHao, TANGPeifu. EFFECTIVENESS OF LOCKING COMPRESS PLATE FOR TREATMENT OF ASEPTIC DIAPHYSEAL HUMERAL NONUNIONS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(10): 1230-1234. doi: 10.7507/1002-1892.20150267 Copy

1.	Brinker MR, O'Connor DP. The incidence of fractures and dislocations referred for orthopaedic services in a capitated population. J Bone Joint Surg (Am), 2004, 86-A(2):290-297.
2.	Volgas DA, Stannard JP, Alonso JE. Nonunions of the humerus. Clin Orthop Relat Res, 2004, (419):46-50.
3.	Willis MP, Brooks JP, Badman BL, et al. Treatment of atrophic diaphyseal humeral nonunions with compressive locked plating and augmented with an intramedullary strut allograft. J Orthop Trauma, 2013, 27(2):77-81.
4.	Lin WP, Lin J. Allografting in locked nailing and interfragmentary wiring for humeral nonunions. Clin Orthop Relat Res, 2010, 468(3): 852-860.
5.	Prasarn ML, Achor T, Paul O, et al. Management of nonunions of the proximal humeral diaphysis. Injury, 2010, 41(12):1244-1248.
6.	Xiong Y, Zhao YF, Xing SX, et al. Comparison of interface contact profiles of a new minimum contact locking compression plate and the limited contact dynamic compression plate. Int Orthop, 2010, 34(5):715-718.
7.	Hoerdemann M, Gédet P, Ferguson SJ, et al. In-vitro comparison of LC-DCP- and LCP-constructs in the femur of newborn calves-a pilot study. BMC Vet Res, 2012, 8:139.
8.	Lloyd GJ, Wright TA. Self-compressing implants in the management of fractures. Can Med Assoc J, 1977, 116(6):626-628.
9.	Weber B, Cech O. Pseudarthrosis:Pathophysiology, Biomechanics, Therapy, Results. New York:Grune&Stratton, 1976.
10.	王志强, 宋会平, 邓华民, 等. 同种异体骨移植术后骨不连成因及治疗方法分析. 中国修复重建外科杂志, 2009, 23(5):534-537.
11.	Flinkkilä T, Ristiniemi J, Hämäläinen M. Nonunion after intramedullary nailing of humeral shaft fractures. J Trauma, 2001, 50(3):540-544.
12.	McKee MD, Miranda MA, Riemer BL, et al. Management of humeral nonunion after the failure of locking intramedullary nails. J Orthop Trauma, 1996, 10(7):492-499.
13.	Patel VR, Menon DK, Pool RD, et al. Nonunion of the humerus after failure of surgical treatment. Management using the Ilizarov circular fixator. J Bone Joint Surg (Br), 2000, 82(7):977-983.
14.	Lin J, Chiang H, Chang DS. Locked nailing with interfragmentary wiring for humeral nonunions. J Orthop Trauma, 2002, 52(4):733-738.
15.	Verbruggen JP, Stapert JW. Failure of reamed nailing in humeral non-union:an analysis of 26 patients. Injury, 2005, 36(3):430-438.
16.	Hierholzer C, Sama D, Toro JB, et al. Plate fixation of ununited humeral shaft fractures:effect of type of bone graft on healing. J Bone Joint Surg (Am), 2006, 88(7):1442-1447.
17.	Ring D, Kloen P, Kadzielski J, et al. Locking compression plates for osteoporotic nonunions of the diaphyseal humerus. Clin Orthop Relat Res, 2004, (425):50-54.
18.	Lin CL, Fang CK, Chiu FY, et al. Revision with dynamic compression plate and cancellous bone graft for aseptic nonunion after surgical treatment of humeral shaft fracture. J Trauma, 2009, 67(6):1393-1396.
19.	Kontakis GM, Tosounidis T, Pagkalos J. Humeral diaphyseal aseptic non-unions:an Algorithm of management. Injury, 2007, 38 Suppl 2: S39-49.
20.	Lim KE, Yap CK, Ong SC, et al. Plate osteosynthesis of the humerus shaft fracture an its association with radial nerve injury- a retrospective study in Melaka General Hospital. Med J Malaysia, 2001, 56 Suppl C:8-12.
21.	Paris H, Tropiano P, Clouet D'orval B, et al. Fractures of the shaft of the humerus:systematic plate fixation. Anatomic and functional results in 156 cases and a review of the literature. Rev Chir Orthop Reparatrice Appar Mot, 2000, 86(4):346-359.
22.	曾炳芳, 康庆林. 四肢骨不连外科学. 北京:人民军医出版, 2010: 328-329.

1. Brinker MR, O'Connor DP. The incidence of fractures and dislocations referred for orthopaedic services in a capitated population. J Bone Joint Surg (Am), 2004, 86-A(2):290-297.
2. Volgas DA, Stannard JP, Alonso JE. Nonunions of the humerus. Clin Orthop Relat Res, 2004, (419):46-50.
3. Willis MP, Brooks JP, Badman BL, et al. Treatment of atrophic diaphyseal humeral nonunions with compressive locked plating and augmented with an intramedullary strut allograft. J Orthop Trauma, 2013, 27(2):77-81.
4. Lin WP, Lin J. Allografting in locked nailing and interfragmentary wiring for humeral nonunions. Clin Orthop Relat Res, 2010, 468(3): 852-860.
5. Prasarn ML, Achor T, Paul O, et al. Management of nonunions of the proximal humeral diaphysis. Injury, 2010, 41(12):1244-1248.
6. Xiong Y, Zhao YF, Xing SX, et al. Comparison of interface contact profiles of a new minimum contact locking compression plate and the limited contact dynamic compression plate. Int Orthop, 2010, 34(5):715-718.
7. Hoerdemann M, Gédet P, Ferguson SJ, et al. In-vitro comparison of LC-DCP- and LCP-constructs in the femur of newborn calves-a pilot study. BMC Vet Res, 2012, 8:139.
8. Lloyd GJ, Wright TA. Self-compressing implants in the management of fractures. Can Med Assoc J, 1977, 116(6):626-628.
9. Weber B, Cech O. Pseudarthrosis:Pathophysiology, Biomechanics, Therapy, Results. New York:Grune&Stratton, 1976.
10. 王志强, 宋会平, 邓华民, 等. 同种异体骨移植术后骨不连成因及治疗方法分析. 中国修复重建外科杂志, 2009, 23(5):534-537.
11. Flinkkilä T, Ristiniemi J, Hämäläinen M. Nonunion after intramedullary nailing of humeral shaft fractures. J Trauma, 2001, 50(3):540-544.
12. McKee MD, Miranda MA, Riemer BL, et al. Management of humeral nonunion after the failure of locking intramedullary nails. J Orthop Trauma, 1996, 10(7):492-499.
13. Patel VR, Menon DK, Pool RD, et al. Nonunion of the humerus after failure of surgical treatment. Management using the Ilizarov circular fixator. J Bone Joint Surg (Br), 2000, 82(7):977-983.
14. Lin J, Chiang H, Chang DS. Locked nailing with interfragmentary wiring for humeral nonunions. J Orthop Trauma, 2002, 52(4):733-738.
15. Verbruggen JP, Stapert JW. Failure of reamed nailing in humeral non-union:an analysis of 26 patients. Injury, 2005, 36(3):430-438.
16. Hierholzer C, Sama D, Toro JB, et al. Plate fixation of ununited humeral shaft fractures:effect of type of bone graft on healing. J Bone Joint Surg (Am), 2006, 88(7):1442-1447.
17. Ring D, Kloen P, Kadzielski J, et al. Locking compression plates for osteoporotic nonunions of the diaphyseal humerus. Clin Orthop Relat Res, 2004, (425):50-54.
18. Lin CL, Fang CK, Chiu FY, et al. Revision with dynamic compression plate and cancellous bone graft for aseptic nonunion after surgical treatment of humeral shaft fracture. J Trauma, 2009, 67(6):1393-1396.
19. Kontakis GM, Tosounidis T, Pagkalos J. Humeral diaphyseal aseptic non-unions:an Algorithm of management. Injury, 2007, 38 Suppl 2: S39-49.
20. Lim KE, Yap CK, Ong SC, et al. Plate osteosynthesis of the humerus shaft fracture an its association with radial nerve injury- a retrospective study in Melaka General Hospital. Med J Malaysia, 2001, 56 Suppl C:8-12.
21. Paris H, Tropiano P, Clouet D'orval B, et al. Fractures of the shaft of the humerus:systematic plate fixation. Anatomic and functional results in 156 cases and a review of the literature. Rev Chir Orthop Reparatrice Appar Mot, 2000, 86(4):346-359.
22. 曾炳芳, 康庆林. 四肢骨不连外科学. 北京:人民军医出版, 2010: 328-329.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF LOCKING COMPRESS PLATE FOR TREATMENT OF ASEPTIC DIAPHYSEAL HUMERAL NONUNIONS

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