Humeral shaft non-union after intramedullary nailing.

Area of Science:

• Orthopedic surgery
• Traumatology
• Regenerative medicine

Background:

• Humeral shaft fractures have a high risk of non-union (pseudoarthrosis).
• Atrophic pseudoarthrosis of the humeral shaft is a challenging clinical problem.
• Previous intramedullary nailing attempts can fail to achieve union.

Purpose of the Study:

• To evaluate the efficacy of angular stability plate fixation combined with allograft and platelet-rich plasma (PRP) for treating humeral shaft pseudoarthrosis.
• To assess functional outcomes and radiographic healing in patients with recalcitrant humeral shaft non-union.

Main Methods:

• Nine patients with atrophic humeral shaft pseudoarthrosis, previously treated with intramedullary nails, underwent surgery.
• Treatment involved angular stability plate fixation, cortical bone allograft, and PRP.
• Functional outcomes were assessed using Constant, DASH, and UCLA scores.

Main Results:

• Radiographic healing was achieved at an average of 7 months post-operatively.
• At a mean follow-up of 23.7 months, functional scores improved significantly (mean DASH 22.25, Constant 64, UCLA 27).
• Patients reported substantial pain reduction in the affected arm.

Conclusions:

• The combination of angular stability plate, allograft, and PRP provides a high-stability construct for treating humeral shaft non-union.
• This surgical approach promotes effective bone healing and graft integration.
• Successful treatment of humeral shaft non-union improves daily living and function.