Open Reduction and Internal Fixation for Humeral Shaft Nonunion: Bone Grafting Is Not Routinely Required and Avoids Donor Site Morbidity

Objectives: To document union rate, complications and patient-reported outcomes after open reduction internal fixation (ORIF), with without bone grafting (BG), for humeral diaphyseal nonunion failed nonoperative management. Design: Retrospective. Setting: University teaching hospital. Patients Intervention: From 2008 to 2017, 86 consecutive patients [mean age 59 years (range 17–86), 71% (n = 61/86) women] underwent ORIF (plate screws) at a mean of 7 months postinjury 3–21.5). Eleven (13%) supplementary BG. Main Outcome Measurements: Union rate 83 (97%) 10 (3–61). Patient-reported (QuickDASH, EQ-5D, EQ-VAS, SF-12, satisfaction) 53 living, cognitively-intact (78%) 4.9 (0.3–9.2). Results: Ninety-three percent 77/83) achieved ORIF. Complications included recalcitrant (7%, n 6/83), iatrogenic radial nerve palsy (6%, 5/83), infection (superficial 7%, 6/83; deep 2%, 2/83), iliac crest donor site morbidity (38%, 3/8). The BG was 78% 7/9) 95% 70/74; P 0.125), not associated the type (atrophic 91%, 53/58; hypertrophic 96%, 24/25; 0.663). Median QuickDASH 22.7 (0–95), EQ-5D 0.710 (?0.181-1), EQ-visual analog scale 80 (10–100), SF-12 physical component summary 41.9 (16–60.5), mental 52.6 (18.7–67.7). Nineteen 10/53) were dissatisfied their outcome. Conclusions: high union. Routine required avoided risk morbidity. One in 5 despite majority achieving Level Evidence: Therapeutic III. See Instructions Authors complete description levels evidence.