Review Question - QID 7834

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Humeral Shaft Nonunion Treatment Operative QID: 7834 (SAE11UE.46)

QID 7834 (Type "7834" in App Search)

A 45-year-old man has been treated nonsurgically with a fracture brace for a closed midshaft humeral fracture. At 16 weeks after his injury he has continued pain and gross motion at the fracture site. A radiograph is shown in Figure 46. What is the most appropriate and reliable management at this point?

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Sling immobilization and electrical stimulation

7/486

Continued functional bracing and repeat radiographs in 6 weeks

27/486

Closed reduction and intramedullary nailing

22/486

Open reduction and plating with autograft

79%

385/486

Open reduction with fully locked plating and allograft

33/486

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The radiograph reveals a delayed union of a midshaft humerus fracture that has been treated appropriately with closed fracture bracing. The gold standard remains compression plate fixation with autograft, most commonly iliac crest bone graft. Intramedullary nailing is associated with a higher incidence of nonunion and iatrogenic rotator cuff damage. Fully locked plating is unnecessary along with allograft in this setting. Immobilization with electrical stimulation offers little success in this atrophic delayed union.

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2.7

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