Nonunion of the humeral diaphysis - operative and nonoperative treatment

Operative treatment of acute humeral shaft fractures represents a major sou rce of nonunions. The analysis of the biomechanical and biological causes o f diaphyseal nonunions of the humerus is a prerequisite for the successful treatment of ununited humeral shaft fractures. Biologically active nonunion s heal after debridement and correction of deformities with an improvement of mechanical stability preferably by fixation with a compression plate. In atrophic nonunions, the restoration of the biologic capacity to restore os teogenesis by bone grafting is additionally necessary. The treatment of syn ovial pseudarthrosis and infected non-union requires removal of bone and de bridement of synovial and infected avascular tissues, respectively. Intrame dullary nails to improve mechanical stability and nonoperative treatment wi th extracorporeal shock waves should only be used in a few special cases wh ich do not have any severe deformities.