Treatment of Surgical Neck Nonunions of the Humerus with Locked Plate and Autologous Fibular Strut Graft

Abstract

OBJECTIVES: To determine whether using a fixed-angle locked plate plus a fibular strut autograft to treat humeral surgical neck nonunions can result in improved union. PATIENTS AND METHODS: The study cohort included 5 females and 2 males with an average age of 58.4 years (range 45-76) who presented with atrophic nonunion of the surgical neck of the humerus. All patients underwent revision surgery with locked plating plus a nonvascularized autologous fibular strut bone graft. Clinical and radiological union was documented in all patients. RESULTS: The mean time from initial trauma to last revision surgery was 20.1 ± 12.6 months (range 12-48). The average time between revision surgery and the date of union was 6.1 months (range 5-8). The average active forward flexion was 124° (range 70-160) at final follow-up. The Constant-Murley score increased from an average of 25.7 points preoperatively to 77.7 points postoperatively (p < 0.001). The average analog scale of pain decreased from 7.57 points (range 6-10) preoperatively to 0.57 points (range 0-2) postoperatively (p < 0.001). CONCLUSIONS: Locked plate fixation and autologous fibular strut bone graft facilitated the successful treatment of humeral surgical neck nonunions.