J Korean Fract Soc.  2008 Jan;21(1):45-50. 10.12671/jkfs.2008.21.1.45.

Nonunion with a Bony Defect of the Humerus: Treatment by Shortening

• Lee JS
• Kang SY
• Yoo JH

• KMID: 1480963
• DOI: http://doi.org/10.12671/jkfs.2008.21.1.45

Abstract

PURPOSE: To evaluate clinical results and advantage of interposition and shortening technique for the treatment of the humeral nonunion with bone defect.
MATERIALS AND METHODS
Eight patients with the humeral nonunion with bone defect underwent interposition of fragments and shortening had been followed-up for more than one year (mean 70 months, 16~156). There were 4 men and 4 women with a mean age of 60.5 years (range, 48 to 75 years). There included 3 proximal, 3 diaphysis and 2 distal metaphysis according to the site, mean size of the bone defect was 3.3 cm (2~5). The time to union, discrepancy of upper extremity, functional results, cosmetic satisfaction and postoperative complications were assessed.
RESULTS
All patients achieved to bone union, average union time was 10.2 weeks (range 8~14). Average limb discrepancy was 2.3 cm. All had improvement in shoulder and elbow motion after operation. Seven patients were satisfied with the cosmetic result and none had functional deficit due to limb discrepancy.
CONCLUSION
Treatment by Interposition of fragments and shortening in the intractable nonunion of humerus with a bony defect can achieve not only good functional result, shortened bone union time and improved in shoulder and elbow motion.

Keyword

Humerus; Nonunion; Bony defect; Shortening

MeSH Terms

Cosmetics
Diaphyses
Elbow
Extremities
Female
Humans
Humerus
Imidazoles
Male
Nitro Compounds
Postoperative Complications
Shoulder
Upper Extremity
Cosmetics
Imidazoles
Nitro Compounds

Figure

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  Fig. 1 Schematic illustration of the shortening and interposition technique.

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  Fig. 2 50-year-old woman presented with pain and motion limitation of left elbow. (A) Preoperative radiograph shows nonunion with 5 cm bone defect of supracondylar area of the humerus. (B) Postoperative radiograph shows interposition of the distal fragment to the proximal fragment and external fixation. (C) 12 months after operation, bone union was achieved. (D) The arc of ulnohumeral motion was checked 20 to 110 degree and limb discrepancy was checked 4.5 cm.

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  Fig. 3 75 year-old male presented with pain and weakness of right arm after opearative fixation of a fracture of the distal shaft of the humerus. (A) Anteroposterior radiograph demonstrating nonunion with bony defect and screw loosening. (B) The preoperative plan. (C) 2 months after a wave plate and autogenous bone graft had been applied, bone union was achieved and the limb discrepancy wad checked 2 cm.

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