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Reassurance and appropriate followup
1%
12/1061
Sarmiento bracing
10/1061
Use of a bone stimulator
3%
28/1061
Exchange humeral nailing
10%
106/1061
IM nail removal, open reduction internal fixation with bone grafting
84%
893/1061
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This patient has developed a hypertrophic non-union of his left humerus following IM nailing. This will not go on to union without surgical intervention. McKee et al. reviewed 21 cases of humeral nonunion after failed intramedullary humeral nails. Although technically difficult, open reduction internal fixation with plating and bone grafting was more successful in union in 9/9 cases, vs exchanged humeral nailing which was only successful in 4/10 cases. Seven of the nonunions were atrophic, 2 were hypertrophic in the ORIF group. The authors conclude that the extent of humeral bone loss after failure of primary humeral nailing makes open reduction internal fixation with compression and bone grafting the most acceptable method of treating this problem. It should be noted, however, that the use of bone grafting in the presence of a hypertrophic nonunion is controversial and has not been definitively proven in the literature to increase healing rates.
3.2
(32)
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