Treatment of Humeral Nonunions With Cancellous Allograft, Demineralized Bone Matrix, and Plate Fixation

摘要

Autologous iliac crest bone graft is routinely recommended in the treatment of humeral nonunions. Due to the risks inherent in autograft harvest, we evaluated 11 patients (mean age 62 years; 5 males and 6 females) with humeral nonunions who were treated with allograft, demineralized bone matrix, and plate fixation to determine their clinical outcome. The mean duration of the nonunion was 24 months (range, 4 - 120 months). At a mean follow-up of 33 months (range, 25-42 months; minimum 2 years) 10 of the 11 nonunions (91%) had healed. One patient required a second operation to gain union. The nonunion that failed to heal eventually required a hemiarthroplasty, secondary to blade plate cut out of the humeral head. Patient outcomes were evaluated with the D.A.S.H. questionnaire demonstrating 4 excellent, 5 good, 2 fair, and no poor results at follow-up. All patients had functional shoulder and elbow motion. These results show that allograft and demineralized bone matrix can be a useful adjunct to plate fixation in the treatment of humeral nonunions.