Abstract

Introduction: Non-union are the most common complications of diaphyseal fractures of the humerus. The management of this condition varies on the type of pseudarthrosis. The objective of the study was to assess the results of our treatment.

Patients and methods: We conducted a retro-prospective study between April 2011 and March 2016, involving 50 cases of non-union of the humeral shaft in our department. Non Septic non-unions without bone defect were treated by osteomuscular decortication with or without iliac grafting. The patients were aged 18 years or older, followed and evaluated at a minimum follow-up of 12 months. The non-unions were distributed by septicity and vitality based on Weber and Čech classification. The osteomuscular decortication with or without iliac graft was the most used surgical technique. The Stewart-Hundley criteria were used to assess the functional results of the affected arms. The data were analyzed using Epi info 2010 version 3.5.2. The Chi2 test was used to compare the pre-operative and post-operative outcomes for a significance level retained at 0.05.

Results: There were 47 cases (94%) of vital non-union and 3 cases (6%) of non-vital humeral shaft non-union. One pseudarthrosis was septic. The osteosynthesis used plate in 46 cases (92%), intramedular pinning in 3 cases (6%) and the external fixator in the only case of septic pseudarhtrosis after recovery from infection (2%). The postoperative was free of infection and disassembly of the ostheosynthesis material allowing to significantly reduce the risk of complications (RR 0.84) (95% CI 0.7443-0.948) (p = 0.0014). All the patients consolidated (p = 0.000). The mean time to union was 17.2 weeks (range: 10 and 22). The postoperative functional results according to the Stewart and Hundley score compared to the preoperative ones were very good in 35 cases (70%), good in 13 cases (26%) and quite good in 2 cases (4%) (P = 0.0000) (95% CI: 5.108-243.8).

Conclusion: The treatment of non-union of the humerus shaft without defect by osteomuscular decortication and osteosynthesis using plate leads to a bone, with satisfactory clinical and functional outcomes.