Union rate after operative treatment of humeral shaft nonunion - A systematic review

Introduction Humeral shaft nonunions can lead to morbidity from subsequent operations, complications and impaired function. Currently there is no evidenced-based consensus for treatment of humeral shaft nonunions. Aim We aimed to summarize and analyze union rates and complications after operative treatment for humeral shaft nonunion. Methods Studies investigating operative treatment strategies for humeral shaft nonunion were identified by searching: EMBASE, MEDLINE, Ovid SP, Web of Science, Cochrane Central, PubMed and Google Scolar up to October 24, 2014. Studies were eligible if: (1) outcome of operative treatment for humeral shaft nonunion was reported; (2) at least ten adult patients with humeral shaft nonunion included; (3) full text article available; (4) written in English, German or Dutch; and (5) nonunion was defined as no bone-bridging between the fracture ends after 6 months. Results Thirty-six studies were included. A union rate of 98% was found in patients (n = 672) who underwent plate fixation with autologous bone grafting (ABG), 95% in plate fixation without ABG (n = 19), 88% in intramedullary nailing with ABG (n = 164), 66% in intramedullary nailing without ABG (n = 78), 92% in bone strut fixation (n = 91) and 98% in external fixation (n = 152). A total complication rate of 12% was found in patients treated with plate fixation combined with ABG, 15% in intramedullary nail with ABG and 8% intramedullary nailing without ABG, 20% in bone strut fixation and 22% in external fixation. Conclusion Plate fixation with ABG was recommended for humeral shaft nonunion, since the union rate is highest and the complication rate is relatively low. Level of evidence Level IV.