Treatment of humeral shaft delayed unions and nonunions with humeral locked nails

Objective: To report experience with use of humeral locked nails in treatin g humeral delayed unions and nonunions, The following techniques yielded en couragingly good results: static locking, short-to-long segment nailing, bo ne grafting, fracture compression, and minimal surgical trauma. Design and Methods: A total of 41 consecutive patients with 13 delayed unio ns and 28 nonunions were treated with humeral locked nails. Delay from trau ma to surgery averaged 4.2 months for delayed union and 15.5 months for non union, The average age of patients was 50.2 years; average follow-up time w as 23.2 months. There were 7 proximal-third fractures, 21 middle-third frac tures, and 13 distal-third fractures, The antegrade approach was used for 1 3 fractures and retrograde for 28, Open nailing was performed in 39 fractur es and closed nailing in 2, If the fracture motion was still present after nail insertion, axial compression of the fracture site was specially applie d. Bone grafting was performed in the fractures with open nailing, Thirty-f our fractures were nailed with 8-mm nails, and 7 fractures were nailed with 7-mm nails. Results: With a single operation, all but two patients achieved osseous uni on in, on average, 5.6 months. One of these two patients eventually gained union after another surgery with fracture compression along the original na il and concurrent bone grafting. The second patient, undergoing hemodialysi s for chronic renal failure, had persistent nonunion, At follow-up, for pat ients with antegrade nailing, all but four patients had less than 20 degree s limitation of shoulder abduction, For patients with retrograde nailing, a ll but two had less than 10 degrees limitation of elbow motion, Only the pa tient with persistent nonunion had continual pain and significant impairmen t of arm function. Conclusions: Humeral locked nailing seems to be effective for humeral delay ed unions or nonunions. It may be an acceptable alternative for fractures u nsuited for plate fixation, such as those with comminution, osteoporosis, o r a severely adhered radial nerve.