Humeral shaft nonunions: plates and nails

Objectives: This study aims to compare the functional results of dynamic compression plates (DCP) and interlocked retrograde intramedullary nails (IRIN) used for the treatment of humeral shaft nonunions. Patients and methods: Twenty-six patients (12 males, 14 females; mean age, 42.8 years; range 21 to 61 years) who underwent surgical treatment of humeral shaft nonunion either with DCP (n=13) or IRIN (n=13) between October 1999 and January 2008, were retrospectively analyzed. Treatment consisted of removing previous implants and DCP or IRIN fixation with additional autogenous bone grafts for atrophic nonunions. Union time, range of motion, radiographic length difference, Constant-Murley Scale (CMS), Disabilities of the Arm, Shoulder and Hand (DASH-T) and Mayo Elbow Performance Score (MEPS) were evaluated at a mean follow-up time of 59.5 months (range; 17 to 125 months). Results: There was a statistically significant correlation among the functional scores of DASH-T, MEPS and CMS. No statistically significant difference was observed in the functional outcome between the groups (DCP and IRIN). Range of motion of the elbow joint was significantly impaired in three patients who were plated for distal shaft nonunions. Conclusion: Both DCP and IRIN provide satisfactory functional outcomes in the treatment of humeral shaft nonunions. Distal shaft nonunions may demonstrate a decrement in elbow motion associated with distal placement of plates.