Outcomes of Humerus Nonunion Surgery in Patients With Initial Operative Fracture Fixation

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Musculoskeletal Research

Background:

• Humerus aseptic nonunion after initial operative fracture management presents a significant clinical challenge.
• Understanding outcomes and risk factors for revision surgery is crucial for patient management.

Purpose of the Study:

• To describe outcomes of humerus aseptic nonunion surgery in patients with prior operative treatment.
• To identify risk factors associated with nonunion surgery failure in this population.

Main Methods:

• Retrospective case series conducted across eight academic level 1 trauma centers.
• Included 90 patients with aseptic humerus nonunion (OTA/AO 11 and 12) treated between 1998 and 2019.
• Analyzed success rates, complications, and risk factors for recalcitrant nonunion.

Main Results:

• Overall union rate following nonunion surgery was 78.9% (71/90 patients).
• 33.3% of patients experienced postoperative complications, including infection and fixation failure.
• Failure to perform revision internal fixation and de novo postoperative infection were significant risk factors for recalcitrant nonunion (P = 0.002 and P = 0.005, respectively).

Conclusions:

• Over 20% of patients failed nonunion repair, highlighting the complexity of treating previously operated aseptic humerus nonunions.
• Postoperative infection and inadequate revision fixation are key predictors of treatment failure.
• Smoking status and bone graft use did not significantly impact nonunion repair success rates.