Effectiveness of locking compress plate and extra cortical bone bridge fixation for treatment of atrophic humeral nonunions_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WU Min , GUAN Jianzhong , XIAO Yuzhou , DAI Xiusong , LI Yonghao , BAO Zhengqi , WANG Zhaodong , CHEN Xiaotian

Department of Orthopedics, the First Affiliated Hospital of Bengbu Medical College, Laboratory of Tissue and Transplant in Anhui Province, Bengbu Anhui, 233003, P.R.China;

Corresponding author：

WU Min, Email: wumin200207@163.com

Keywords：

Humeral shaft fracture; atrophic nonunion; bone graft; extra cortical bone bridging

DOI：

10.7507/1002-1892.201610021

Video：

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Objective To assess the effectiveness of locking compress plate and extra cortical bone bridge fixation for treating atrophic humeral nonunion. Methods Seventeen patients with atrophic humeral nonuninon were treated with locking compress plate and extra cortical bone bridge fixation between November 2006 and June 2015. Of 17 cases, 11 were male, 6 were female, aged 24-63 years (mean, 38.2 years). Fracture located at the left side in 9 cases and at the right side in 8 cases. The mechanism of injury was traffic accident in 13 cases, falling from height in 3 cases, and heavy pound injury in 1 case. The patients underwent surgery for 1 time in 7 cases, for 2 times in 5 cases, for 3 times in 4 cases, and for 4 times in 1 case. The time from fracture to hospitalization was 10-76 months (mean, 22.6 months). The shoulder function was evaluated by Neer score, and elbow function by Mayo score. Results All incisions healed by first intention. Two cases had transient radial nerve symptoms of numbness. All patients were followed up 27.3 months on average (range, 15-60 months). Radiographic examination showed signs of bone remodeling at 6-8 weeks after operation, and formation of extra cortical bone bridge. All of them achieved bone union within 10 to 41 weeks (mean, 17.6 weeks). At last follow-up, the average Neer score was 83.36 (range, 72-96); and the shoulder function was excellent in 10 cases, good in 5, and fair in 2 with an excellent and good rate of 88.24%. And the average Mayo score was 86.52 (range, 68-100); and the elbow function was excellent in 11 cases, good in 3, and fair in 3 with an excellent and good rate of 82.35%. Conclusion The bone bridging could effectively form by extra cortical grafting technique. Atrophic humeral nonunions can be successfully treated with locking compress plate and extra cortical bone bridge fixation.

Citation： WUMin, GUANJianzhong, XIAOYuzhou, DAIXiusong, LIYonghao, BAOZhengqi, WANGZhaodong, CHENXiaotian. Effectiveness of locking compress plate and extra cortical bone bridge fixation for treatment of atrophic humeral nonunions. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(1): 1-4. doi: 10.7507/1002-1892.201610021 Copy

1.	Atalar AC, Kocaoglu M, Demirhan M, et al. Comparison of three different treatment modalities in the management of humeral shaft nonunions (plates, unilateral, and circular external fixators). J Orthop Trauma, 2008, 22(4): 248-257.
2.	Frölke JP, Patka P. Definition and classification of fracture non-unions. Injury, 2007, 38 Suppl 2: S19-22.
3.	Metikala S, Bhogadi P. Orthogonal Double Plating and Autologous Bone Grafting of Postoperative Humeral Shaft Nonunion-A Rare Case Report and Review of Literature. J Orthop Case Rep, 2015, 5(4): 50-53.
4.	Livani B, Belangero W, Medina G, et al. Anterior plating as a surgical alternative in the treatment of humeral shaft non-union. Int Orthop, 2010, 34(7): 1025-1031.
5.	陈继营, 王岩, 卢世璧, 等. 皮质外骨桥固定特制假体置换治疗肢体骨肿瘤. 中国矫形外科杂志, 2005, 13(17): 1301-1303.
6.	Peters RM, Claessen FM, Doornberg JN, et al. Union rate after operative treatment of humeral shaft nonunion—A systematic review. Injury, 2015, 46(12): 2314-2324.
7.	Kumar MN, Ravindranath VP, Ravishankar M. Outcome of locking compression plates in humeral shaft nonunions. Indian J Orthop, 2013, 47(2): 150-155.
8.	王浩杰, 索鹏, 陈坚, 等. 自体髂骨骨板螺钉内固定加外固定架治疗肱骨干萎缩型骨不连. 中国骨与关节损伤杂志, 2009, 24(2): 133-134.
9.	Carroll EA, Schweppe M, Langfitt M, et al. Management of humeral shaft fractures. J Am Acad Orthop Surg, 2012, 20(7): 423-433.
10.	Singh AK, Arun GR, Narsaria N, et al. Treatment of non-union of humerus diaphyseal fractures: a prospective study comparing interlocking nail and locking compression plate. Arch Orthop Trauma Surg, 2014, 134(7): 947-953.
11.	Cadet ER, Yin B, Schulz B, et al. Proximal humerus and humeral shaft nonunions. J Am Acad Orthop Surg, 2013, 21(9): 538-547.
12.	Padhye KP, Kulkarni VS, Kulkarni GS, et al. Plating, nailing, external fixation, and fibular strut grafting for non-union of humeral shaft fractures. J Orthop Surg (Hong Kong), 2013, 21(3): 327-331.
13.	Chao EY, Fuchs B, Rowland CM, et al. Long-term results of segmental prosthesis fixation by extracortical bone-bridging and ingrowth. J Bone Joint Surg (Am), 2004, 86-A(5): 948-955.
14.	Shin DS, Choong PF, Chao EY, et al. Large tumor endoprostheses and extracortical bone-bridging: 28 patients followed 10-20 years. Acta Orthop Scand, 2000, 71(3): 305-311.
15.	Virolainen P, Inoue N, Nagao M, et al. The effect of multidrug chemotherapy on bone graft augmented prosthesis fixation. J Orthop Res, 2005, 23(4): 795-801.
16.	陈继营, 王岩, 卢世璧, 等. 皮质外骨桥固定特制假体置换治疗肢体骨肿瘤. 中国矫形外科杂志, 2005, 13(17): 1301-1303.

1. Atalar AC, Kocaoglu M, Demirhan M, et al. Comparison of three different treatment modalities in the management of humeral shaft nonunions (plates, unilateral, and circular external fixators). J Orthop Trauma, 2008, 22(4): 248-257.
2. Frölke JP, Patka P. Definition and classification of fracture non-unions. Injury, 2007, 38 Suppl 2: S19-22.
3. Metikala S, Bhogadi P. Orthogonal Double Plating and Autologous Bone Grafting of Postoperative Humeral Shaft Nonunion-A Rare Case Report and Review of Literature. J Orthop Case Rep, 2015, 5(4): 50-53.
4. Livani B, Belangero W, Medina G, et al. Anterior plating as a surgical alternative in the treatment of humeral shaft non-union. Int Orthop, 2010, 34(7): 1025-1031.
5. 陈继营, 王岩, 卢世璧, 等. 皮质外骨桥固定特制假体置换治疗肢体骨肿瘤. 中国矫形外科杂志, 2005, 13(17): 1301-1303.
6. Peters RM, Claessen FM, Doornberg JN, et al. Union rate after operative treatment of humeral shaft nonunion—A systematic review. Injury, 2015, 46(12): 2314-2324.
7. Kumar MN, Ravindranath VP, Ravishankar M. Outcome of locking compression plates in humeral shaft nonunions. Indian J Orthop, 2013, 47(2): 150-155.
8. 王浩杰, 索鹏, 陈坚, 等. 自体髂骨骨板螺钉内固定加外固定架治疗肱骨干萎缩型骨不连. 中国骨与关节损伤杂志, 2009, 24(2): 133-134.
9. Carroll EA, Schweppe M, Langfitt M, et al. Management of humeral shaft fractures. J Am Acad Orthop Surg, 2012, 20(7): 423-433.
10. Singh AK, Arun GR, Narsaria N, et al. Treatment of non-union of humerus diaphyseal fractures: a prospective study comparing interlocking nail and locking compression plate. Arch Orthop Trauma Surg, 2014, 134(7): 947-953.
11. Cadet ER, Yin B, Schulz B, et al. Proximal humerus and humeral shaft nonunions. J Am Acad Orthop Surg, 2013, 21(9): 538-547.
12. Padhye KP, Kulkarni VS, Kulkarni GS, et al. Plating, nailing, external fixation, and fibular strut grafting for non-union of humeral shaft fractures. J Orthop Surg (Hong Kong), 2013, 21(3): 327-331.
13. Chao EY, Fuchs B, Rowland CM, et al. Long-term results of segmental prosthesis fixation by extracortical bone-bridging and ingrowth. J Bone Joint Surg (Am), 2004, 86-A(5): 948-955.
14. Shin DS, Choong PF, Chao EY, et al. Large tumor endoprostheses and extracortical bone-bridging: 28 patients followed 10-20 years. Acta Orthop Scand, 2000, 71(3): 305-311.
15. Virolainen P, Inoue N, Nagao M, et al. The effect of multidrug chemotherapy on bone graft augmented prosthesis fixation. J Orthop Res, 2005, 23(4): 795-801.
16. 陈继营, 王岩, 卢世璧, 等. 皮质外骨桥固定特制假体置换治疗肢体骨肿瘤. 中国矫形外科杂志, 2005, 13(17): 1301-1303.

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