An alternative treatment for aseptic humeral shaft nonunion: intramedullary nailing without grafting

This study evaluates the clinical and functional outcomes of intramedullary nailing without grafting for the treatment of aseptic humeral shaft nonunion.

Between January 2017 and January 2024, 14 patients treated at a single center for humeral shaft fractures diagnosed with nonunion and managed with intramedullary nailing without grafting were retrospectively analyzed. Demographic and clinical characteristics, union status, and preoperative and postoperative range of motion, Visual Analog Scale (VAS), QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand), and Constant-Murley scores were recorded.

The study included 14 patients (nine women, five men) with a mean age of 49.2+-17.5 years (range: 26-80). Nonunion types were oligotrophic in 64.3% (n=9), atrophic in 28.6% (n=4), and hypertrophic in 7.1% (n=1) of cases. The union rate after intramedullary nailing without grafting was 78.5% (11/14). Two patients who did not achieve union underwent nail exchange with iliac autografting, resulting in a total union rate of 92.9% (13/14). The mean time to union was 4.3+-2.8 months (range: 2-12). The mean preoperative and postoperative QuickDASH scores were 89.4+-6.2 and 17.5+-13.3, respectively, while the Visual Analog Scale scores were 7.7+-1.1 and 1.7+-1.1, respectively (p<0.001). Of the three patients who failed to achieve union after initial treatment, two had atrophic nonunion and one had oligotrophic nonunion. A statistically significant association was observed between nonunion type and the need for revision surgery (p<0.01), with atrophic nonunions being significantly more frequent in patients requiring revision. One patient developed adhesive capsulitis, and another patient who underwent revision experienced transient radial nerve palsy with complete functional recovery. Proximal screw loosening was observed in two patients and was recorded as a minor complication.

Intramedullary nailing without grafting is an effective and safe treatment option for aseptic humeral shaft nonunion in selected patients, particularly those previously treated conservatively. However, omission of grafting in cases of atrophic nonunion or during nail exchange procedures may negatively affect healing.