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Persistent non-union of the humeral shaft treated by plating and autologous bone grafting

Abstract : INTRODUCTION: Surgical treatment of persistent non-union of the humeral shaft is a complex situation because of the risk of failure and surgery-related complications. The primary objective of this study was to evaluate clinical and radiological results of a continuous series of persistent non-union treated with plating and bone grafting. The secondary objective was to expose factors contributing to the failure of prior bone union attempts. MATERIAL AND METHODS: Sixteen patients (average age of 52 years) were treated for persistent non-union of the humeral shaft in our department; six of these patients had predisposing comorbidities or addictions. The persistent non-union was treated by plating with autologous bone graft from the iliac crest in a single-stage procedure in 12 cases and a two-stage procedure in three cases; one case was treated with plating and vascularized fibula graft. RESULTS: At a minimum follow-up of 12 months (average 78 months), four (25 %) failed to heal. The 12 other patients had bone union after an average of eight months. The average QuickDASH score was 48 points (18-72). A retrospective analysis of the prior attempts to treat the non-union revealed three cases of unstable fixation, four cases with no osteogenic supply and seven cases of positive microbiological cultures at the non-union site. CONCLUSION: Plating and autologous bone grafting resulted in union in only 75 % of persistent non-union of the humeral shaft. The persistent nature of the humeral shaft non-union could be attributed to deviating from validated rules for surgical treatment and/or the presence of a surgical site infection.
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Submitted on : Wednesday, May 29, 2019 - 10:38:40 AM
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Tristan Pollon, Nicolas Reina, Stéphanie Delclaux, Paul Bonnevialle, Pierre Mansat, et al.. Persistent non-union of the humeral shaft treated by plating and autologous bone grafting. International Orthopaedics, Springer Verlag, 2017, 41 (2), pp.367-373. ⟨10.1007/s00264-016-3267-3⟩. ⟨hal-02143134⟩

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