ABSTRACT

The study aim was to report on the use of intramedullary fibular strut autograft and plate fixation in diaphyseal atrophic non-union of the humerus in elderly obese patients.

Between 2001 and 2006, 4 patients with diaphyseal non-union of the humerus were treated in our institution by intramedullary fibular autograft and AO plate fixation. Average age of the patients was 67 years (range, 65-69) and BMI (Body Mass Index): 39 kg/m2 (range, 35-42.5). There were three females and one male. The patients each had fractures of mid-shaft and junction of middle and proximal thirds. Three were closed fractures and one open fracture had eventual atrophic non-union upon presentation. Data collected retrospectively included grip strength, range of motion, radiographic parameters, and functional outcomes as measured by the DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire.

Patients were followed-up for an average of 4 years (range, 3-6). Union was achieved in all patients in 3. 2 months (range, 3-4) and patients were very satisfied with the treatment. There were no perioperative complications. The average humeral shortening was 2.7 cm (range, 1-5). Preoperative DASH score averaged 58 points (range, 47. 7-70. 5). DASH score at the last follow-up averaged 17 points (range, 9-20. 4).

The surgical treatment of humerus diaphyseal non-unions in elderly and obese patients is not only difficult but also costly. Moreover,time consuming surgical interventions brings life-threatening risks in particular in those patient populations. Thus, we consider this method to be an applicable treatment alternative where humerus diaphyseal union is obtained. (JAREM 2011; 1: 15-7)

Keywords: Humerus diaphyseal, non-union, quadricortical bone grafting, fibular autograft, obesity, elderly patient