Comparison of Three Different Treatment Modalities in the Management of Humeral Shaft Nonunions (Plates, Unilateral, and Circular External Fixators)

OBJECTIVES:To compare 3 different fixation methods for the treatment of humeral shaft nonunions in terms of union time, functional outcome, and complications. DESIGN:Retrospective case series. SETTING:University hospital. PATIENTS:Between 1996 and 2004, 80 patients (mean age, 49; range, 15 to 86; 30 women and 50 men) with nonunions of the humeral shaft were treated surgically in our institution. Circular external fixators (CEF) were used in 35 patients, unilateral limb reconstruction system (LRS) fixators in 24 patients and fixation with plates in 21 patients. INTERVENTION:Surgical procedure included hardware removal in previously operated patients, autogenous grafting in all patients in the plate group and in those patients with atrophic nonunions in the external fixator groups, compression of the nonunion site in all patients. MAIN OUTCOME MEASUREMENTS:Radiological union time, complications, shortening, and disabilities of the arm, shoulder, and hand (DASH) score. RESULTS:Mean follow-up period was 48.1 months (range, 12 to 121). Mean radiological union time was 5.5 months (range, 1.5 to 12) in the CEF group, 5.2 months (range, 3 to 10) in the LRS group, and 5.7 months (range, 3 to 12) in the plate group. Mean DASH score was 23.7 in the CEF group, 18.6 in the LRS group, and 26 in the plate group. There were no statistical differences in terms of union time and the DASH score among the 3 groups. Successful union was achieved in 77 (96.3%) patients. CONCLUSION:Both external fixation and plate fixation produce excellent results in humeral shaft nonunions if applied properly. The procedure can be tailored to the surgeonʼs experience, keeping in mind that plate fixation demonstrates a longer healing time in those cases that had previous surgeries.