The Journal of Bone and Joint Surgery, Vol 72, Issue 5 701-707, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Complex non-union of the humeral diaphysis. Treatment with a medial approach, an anterior plate, and a vascularized fibular graft
JB Jupiter
Massachusetts General Hospital, Boston 02114.
Four obese patients who had atrophic synovial non-union of the humeral
shaft were treated with a medial approach, application of a plate
anteriorly, a vascularized fibular bone graft, and cancellous grafts from
the iliac crest. The average age of the patients was forty years; the
average weight, 105 kilograms (232 pounds); and the average duration of the
non-union, 33.5 months. Each patient had had one to five unsuccessful
previous operations in an attempt to gain union. At an average follow-up of
twenty-seven months, all four non-unions had healed. Three patients had
regained full function of the shoulder and elbow, and the fourth patient
had some limitation of motion of the shoulder due to an antecedent lesion
of the rotator cuff. In one patient, a second plate had been applied
because of inadequate fixation of the original plate proximally. Another
patient had a superficial, partial wound slough, which healed
spontaneously.
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