Kumar Malhar N, Ravindranath V Pratap, Ravishankar Mr
Department of Orthopaedics, HOSMAT Hospital, Bangalore, India.
Indian J Orthop. 2013 Mar;47(2):150-5. doi: 10.4103/0019-5413.108899.
Nonunion of diaphyseal fractures of the humerus are frequently seen in clinical practice (incidence of up to 15% in certain studies) and osteosynthesis using dynamic compression plates, intra medullary nails and Ilizarov fixators have been reported previously. Locking compression plates (LCP) are useful in the presence of disuse osteoporosis, segmental bone loss and cortical defects that preclude strong fixation. We report a prospective followup study of the outcome of the use of LCP for humeral nonunion following failed internal fixation in which implants other than LCP had been used.
Twenty four patients with nonunion of humeral shaft fractures following failed internal fixation were included in the study. The mean followup period was 3.4 years (range: 2.4 to 5.7 years) and the minimum followup period was 2 years. Mean age of the patients was 41.04 years (range: 24 to 57 years). All 24 patients underwent osteosynthesis using LCP and autologous bone grafting (cortico-cancellous iliac crest graft combined with or without fibular strut graft). Main outcome measurements included radiographic assessment of fracture union and pre and postoperative functional evaluation using the modified Constant and Murley scoring system.
23 out of 24 fractures united following osteosynthesis. Average time to union was 16 weeks (range: 10 to 28 weeks). Complications included delayed union (n = 2), transient radial nerve palsy (n = 2) and persistent nonunion (n = 1). Functional evaluation using the Constant and Murley score showed excellent results in 11, good in 10, fair in two and poor outcome in one patient.
Locking compression plating and cancellous bone grafting is a reliable option for achieving union in humeral diaphyseal nonunion with failed previous internal fixation and results in good functional outcome in patients with higher physiological demands.
肱骨干骨折不愈合在临床实践中较为常见（某些研究中发生率高达15%），此前已有使用动力加压钢板、髓内钉和伊里扎洛夫固定器进行骨接合术的报道。锁定加压钢板（LCP）在存在废用性骨质疏松、节段性骨丢失和皮质骨缺损而无法进行牢固固定的情况下很有用。我们报告了一项前瞻性随访研究，该研究针对使用LCP治疗内固定失败后的肱骨不愈合的结果，其中内固定使用的不是LCP。
本研究纳入了24例内固定失败后肱骨干骨折不愈合的患者。平均随访期为3.4年（范围：2.4至5.7年），最短随访期为2年。患者的平均年龄为41.04岁（范围：24至57岁）。所有24例患者均接受了使用LCP的骨接合术和自体骨移植（皮质 - 松质髂嵴骨移植联合或不联合腓骨支撑移植）。主要结局指标包括骨折愈合的影像学评估以及使用改良的Constant和Murley评分系统进行术前和术后功能评估。
24例骨折中有23例在骨接合术后愈合。平均愈合时间为16周（范围：10至28周）。并发症包括延迟愈合（2例）、短暂性桡神经麻痹（2例）和持续性不愈合（1例）。使用Constant和Murley评分进行的功能评估显示，11例结果为优，10例为良，2例为中，1例结果差。
锁定加压钢板固定和松质骨移植是实现既往内固定失败的肱骨干不愈合愈合的可靠选择，并且对于生理需求较高的患者可带来良好的功能结局。
