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  • Title: Treatment of atrophic diaphyseal humeral nonunions with compressive locked plating and augmented with an intramedullary strut allograft.
    Author: Willis MP, Brooks JP, Badman BL, Gaines RJ, Mighell MA, Sanders RW.
    Journal: J Orthop Trauma; 2013 Feb; 27(2):77-81. PubMed ID: 22668548.
    Abstract:
    OBJECTIVE: The aim of this study was to evaluate the effectiveness of thorough debridement and locked compression plating augmented with an intramedullary fibular allograft for the treatment of atrophic diaphyseal humeral nonunions. DESIGN: The study involved a level 4 retrospective case series. SETTING: This study was conducted at a level 1 university trauma center. PATIENTS: Twenty patients with painful atrophic nonunions of the humeral diaphysis were examined. INTERVENTION: This involved a thorough debridement and locked compression plating augmented with an intramedullary fibular allograft. MAIN OUTCOME MEASURES: These were union rate, shoulder range of motion, visual analog scale (VAS) pain, VAS function, patient satisfaction, and American Shoulder and Elbow Surgeons score at latest follow-up. METHODS: Clinical and radiographic examinations were performed preoperatively and postoperatively. VAS pain and function scores were collected preoperatively and postoperatively. Patient satisfaction and ASES scores were recorded at the time of the most recent follow-up. RESULTS: : Bony union was achieved in 19 of 20 patients (95%). The patients demonstrated an average improvement in forward elevation from 65 to 144° (P = 0.001), abduction from 48 to 133° (P < 0.001), external rotation from 34 to 70° (P = 0.05), and internal rotation from S1 to T12 (P = 0.025). VAS pain scores improved from 6.05 to 1.88 (P = 0.032). VAS function scores improved from 2.06 to 7.75 (P = 0.003). The average postoperative ASES score was 76, and the average patient satisfaction was rated 9.3/10. CONCLUSIONS: Atrophic nonunions of the humerus can be successfully treated with debridement of the nonunion, coupled with the use of a fibular allograft and locked compression plating. This technique leads to predictable healing without the morbidity associated with autograft. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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