Implementation of locking compression plate together with intramedullary fibular graft in atrophic type humeral nonunions

Abstract
Objective: This study aims to report the results of locking compression plate along with intramedullary fibular graft that was implemented in patients with the diagnosis of nonunion of humerus diaphysis.

Materials and methods: Five patients, operated between 2000 and 2009 for atrophic type nonunion of humeral diaphysis, were included in this study. Two patients were women (40%) and three were men (60%). The mean age was 49.2 years. Nonunion was found to be on the right humerus of 3 patients and on the left side of 2 patients. Causes of fractures were traffic accident in 2 cases, simple fall in 2 cases, and fall from height in 1 case. Mean duration after the elementary fracture was 70 months. Nonunion was diagnosed at 1/3 proximal humeral diaphysis in 2 patients, 1/3 distal humeral diaphysis in 2 patients, and 1/3 middle humeral diaphysis in one patient. Initially, conservative treatment was chosen for 3 cases and plate-screw osteosynthesis for 2 cases.

Results: Complete union was obtained in all cases radiologically. Mean union time was 20.1 weeks. With a mean of 1.78 cm, shortening was detected in comparative radiographies of both humeri. Mean range of motion at the elbow was 118° in flexion–extension arch of patients. The mean Constant-Murley score was 88 points. There was no complication regarding the operation and graft donor sites.

Conclusion: The management of atrophic type humeral nonunions is difficult. The method that we practice in such patients is a reliable treatment option with its stabile fixation and high union rates.