Functional Outcomes of Patients Treated with Fibula Strut Graft and Double Plate in the Treatment of Recalcitrant Humerus Nonunions

Abstract

Objective: Recalcitrant humerus nonunion is challenging to treat, and plate fixation is a common treatment choice. This study aimed to determine the efficiency of double plating combined with nonvascularized autologous fibular strut allograft in the treatment of atrophic and defective humerus nonunions.Methods: Fourteen patients were surgically treated for recalcitrant humerus malunions. Demographic data (age, gender, dominant side), clinical features, and previous surgical records of the patients were recorded preoperatively. Preoperative Visual Analogous Scale (VAS) and Constant-Murley scores of the patients were recorded before the surgery.Results: 10 (71.4%) of the patients were female, and 4 (28.5%) were male. The mean age was 53.07±9.69 (range, 39-67). 9 (64.3%) of the patients had nonunions on the dominant side. The mean follow-up was 11.14±1.9 months. The complete union was observed in all patients, and the mean union time was 5.1±0.63 months (range, 4.2-6.0). The mean preoperative VAS score was 7.29 ± 0.91 (range, 6-9), and the mean postoperative VAS score was 0.93 ± 0.92 (range, 0-3). VAS scores improved after the surgery (p<0.001). The mean preoperative Constant-Murley score was 53.57 ± 12.17 (range 34-72), and the mean postoperative Constant-Murley score was 86.00 ± 9.21. Constant-Murley scores improved after the surgery (p<0.001). Gender (p=0.635), dominant side involvement (p=0.112), and age (p=0.925) did not correlate with union time.Conclusion: Double plating with autologous nonvascularized fibular grafts is a successful treatment option for recalcitrant humerus atrophic nonunions, especially with bony defects.