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Induced-membrane treatment of refractory humeral non-union with or without bone defect
Julien Gaillard1, Alain-Charles Masquelet2, Pierre Boutroux2
1Service de Chirurgie Orthopédique et Traumatologique-SOS Main, Chirurgie Réparatrice de l'Appareil Locomoteur, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Orthopedic surgery department, American Hospital of Paris, 63, boulevard Victor-Hugo, 92200 Neuilly-sur-Seine, France.
Introduction:
Treatment of humeral non-union with or without bone defect is complex, with non-negligible rates of complication and failure. Few reports focused on management of treatment failure.
Objective:
The study hypothesis was that the induced-membrane technique associated in a 2-stage strategy to internal fixation provides systematic bone healing in refractory humeral non-union.
Material And Methods:
The study included 15 patients, with a median age of 46.6 years, with humeral non-union of a mean 24 months' progression and mean history of 3 attempted revision surgeries. Seven patients showed bone defect, exceeding 5cm in 2 cases. Six had history of radial palsy.
Results:
Consolidation was achieved in all cases, at a mean 4.6 months. Ten patients underwent radial nerve transposition, 6 of whom had shown radial motor nerve palsy; all recovered within 2 to 5 months. There was 1 case of superficial infection, and 1 of seroma.
Discussion:
The induced-membrane technique ensures bone healing due to the biological properties of the membrane; the main drawback is the need for 2-stage surgery. When bone defect exceeds 5cm, a multi-perforated fibula segment can be placed inside the membrane to increase primary stability and enhance bone integration.
Conclusion:
The induced-membrane technique is suited to humeral non-union, with or without bone defect. The 2-stage strategy is mandatory in case of suspected latent infection. In the 2-stage procedure, anteromedial radial nerve transposition facilitates the bone-graft stage.
Level Of Evidence:
IV, retrospective study.
