Outcomes of Humerus Nonunion Surgery in Patients With Initial Operative Fracture Fixation

the Evidence-Based Musculoskeletal Injury and Trauma Collective (EMIT), Noah Harrison, Alexander Hysong, Samuel Posey, Ziqing Yu, Andrew T. Chen, Patrick Pallitto, Michael J. Gardner, Jarrod Dumpe, Hassan Mir, Sharon Babcock, Roman M. Natoli, John D. Adams, Robert D. Zura, Anna N. Miller, Rachel B. Seymour, Joseph R. Hsu, William Obremskey, Susan Odum, Stephen SiumsOlivia Rice, Ainsley Bloomer, Katheryn Peterson, Amber Stanley, Mario Cuadra, Gisele Bailey, Christine Churchill, Meghan Wally, Matthew Braswell, Landon Bulloch, Samuel Cohen-Tanugi, William Haynes, Josef Jolissaint, David MacKnet, Julia Mastracci, Andrew Wohler, Eddie Afetse, Cara Girardi, Hannah Pollock, Juliette Sweeney, Kathryn Leighty, Rodney Arthur, James Michael Ruth, Benjamin Averkamp, Laurence Kempton, Kevin Phelps, Madhav Karunakar, Tamar Roomian, Ishani Sharma, Jenna Jones, Luke Lopas, Hassan Farooq, Colette Hillard, Marc Schatz, Jessica Rivera, Lisa Stang, Thomas Stang, Amy Bauer, Joseph Michalski, Shreyas Kudrimoti, Anna Hemminger, Mir Ibrahim Sajid, Stephanie Tanner, Steven Greene, Becky Snider, Jigyasa Sharma, Harsh Wadhwa, Cara Lai, Arlene Garcia, John B. Michaud, Ryan Seltzer, Malcolm Debaun, Noelle Van Rysselberghe, Clayton Maschoff, Christopher Jamero, Stoddy Carey, Alexander Padovano, Nathaniel Koutlas, Julie Titter, Scott Lewis, Cameron Collins, Steve Hemmerly, Elsa Rodriguez, Daniel E. Pereira, Andres Fidel Moreno, Donald Adams, William Hunter Waddell, Zachary Hong, Gabriella Stribling, Merritt John Thompson, Tracy Johns, Gabriel James Sowards, Martha Holden, Katrina Bang, Kamryn King, Thea Lance

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES:To describe outcomes following humerus aseptic nonunion surgery in patients whose initial fracture was treated operatively and to identify risk factors for nonunion surgery failure in the same population.METHODS:Design:Retrospective case series.Setting:Eight, academic, level 1 trauma centers.Patients Selection Criteria:Patients with aseptic humerus nonunion (OTA/AO 11 and 12) after the initial operative management between 1998 and 2019.Outcome Measures and Comparisons:Success rate of nonunion surgery.RESULTS:Ninety patients were included (56% female; median age 50 years; mean follow-up 21.2 months). Of 90 aseptic humerus nonunions, 71 (78.9%) united following nonunion surgery. Thirty patients (33.3%) experienced 1 or more postoperative complications, including infection, failure of fixation, and readmission. Multivariate analysis found that not performing revision internal fixation during nonunion surgery (n = 8; P = 0.002) and postoperative de novo infection (n = 9; P = 0.005) were associated with an increased risk of recalcitrant nonunion. Patient smoking status and the use of bone graft were not associated with differences in the nonunion repair success rate.CONCLUSIONS:This series of previously operated aseptic humerus nonunions found that more than 1 in 5 patients failed nonunion repair. De novo postoperative infection and failure to perform revision internal fixation during nonunion surgery were associated with recalcitrant nonunion. Smoking and use of bone graft did not influence the success rate of nonunion surgery. These findings can be used to give patients a realistic expectation of results and complications following humerus nonunion surgery.LEVEL OF EVIDENCE:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish
Pages (from-to)168-175
Number of pages8
JournalJournal of orthopaedic trauma
Volume38
Issue number3
DOIs
StatePublished - Mar 1 2024

Keywords

  • aseptic nonunion
  • humerus
  • nonunion

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