Refractory humeral non-union: treatment with photodynamic intramedullary implant IlluminOss® and internal fixation

Refractory humeral non-union: treatment with photodynamic intramedullary implant IlluminOss® and internal fixation

Authors

  • Giuseppe Basile Trauma Unit and Emergency Department, IRCCS Galeazzi Orthopedics Institute
  • Stefania Fozzato
  • Luca Bianco Prevot
  • Riccardo Accetta
  • Quirino Alessandro Petrucci

Keywords:

non-union., intramedullary implant, refractory humeral non-union, pseudoarthrosis, IlluminOss®, humeral shaft fractures

Abstract

Surgically treated humeral shaft fractures can develop into pseudoarthrosis (PSA). Even if PSA is treated according to the proposed literature, refractory non-union of the humerus can be determined. Due to the rarity of this condition, we report our experience in the management of refractory pseudarthrosis of the humerus at the IRCCS Galeazzi Orthopedic Institute (Milan, Italy). We used internal fixation with plate and screws associated with the implant of the IlluminOss® Photodynamic Bone Stabilization System to increase bone stability and improve anchoring of the implant medium. This combined treatment allowed the consolidation of the complex fracture despite the bone loss, ensuring excellent stability of the fracture stumps and constituting a flexible and stable system with the most favourable biomechanical conditions. An increase in refractory PSA cases is likely in the future, due to a higher incidence of surgically treated humeral shaft fractures than in the past. Further studies on the effectiveness of the combined use of plate and screw and the IlluminOss® system will be indispensable.

References

Schoch BS, Padegimas EM, Maltenfort M, Krieg J, Namdari S. Humeral shaft fractures: national trends in management. J Orthop Traumatol. 2017;18(3):259-63.

Smolle MA, Bösmüller S, Puchwein P, Ornig M, Leithner A, Seibert FJ. Complications in humeral shaft fractures - non-union, iatrogenic radial nerve palsy, and postoperative infection: a systematic review and meta-analysis. EFORT Open Rev. 2022;7(1):95-108.

Basile G, Avato FM, Passeri A, et Al. Atrophic pseudarthrosis of humeral diaphyseal fractures: medico-legal implications and methodological analysis of the evaluation. Acta Biomed. 2022: 1;93(3)

Wildemann B, Ignatius A, Leung F, et Al. Non-union bone fractures. Nat Rev Dis Primers. 2021 5;7(1):57.

Rubel I, Kloen P, Campbell D, et al. Open reduction and internal fixation of humeral nonunions: a biomechanical and clinical study. J Bone Joint Surg Am. 2002; 84:1315-22

Foulk D, Szabo R. Diaphyseal humerus fractures: natural history and occurrence of nonunion. Orthopedics. 1995; 18:333-5

Gerber A, Martí R, Jupiter J. Surgical treatment of diaphyseal humeral nonunion after intramedullary nailing: wave fixing plate and autologous bone grafting without nail removal. J Shoulder Elbow Surg. 2003, 12 (4) :309-313.

Van Houwelingen A, McKee M. Treatment of osteopenic humeral shaft non-union with compression plating, humeral cortical allograft struts, and bone grafting. J Orthop Trauma. 2005; 19:36-42

Patel V, Menon D, Pool R, Simonis R. Nonunion of the humerus after failure of surgical treatment. Management using the Ilizarov circular fixator. J Bone Joint Surg Br. 2000; 82:977-83.

Basile G, Accetta R, Marinelli S, et Al. Traumatology: Adoption of the Sm@rtEven Application for the Remote Evaluation of Patients and Possible Medico‐Legal Implications. J Clin Med. 2022 Jun 23;11(13): 3644.

Basile G. Remarks on the management of proximal femoral fractures in times of COVID-19 pandemic. Clin Ter. 2022;173(5):398-399.

Marti R, Verheyen C, Besselaar P. Humeral shaft nonunion: evaluation of uniform surgical repair in fifty-one patients. J Orthop Trauma. 2002; 16:108-15

Healy WL, White GM, Mick CA, Brooker AF, Weiland AJ. Non-union of humeral shaft. Clin Orthop. 1987, 219:206-213.

Barquet A, Fernandez A, Luvizio J, Masliah R: A combined therapeutic protocol for aseptic nonunion of the humeral shaft: a report of 25 cases J Trauma, 29 (1989): 95-98.

Hsu TL, Chiu FY, Chen CM, Chen TH. Treatment of nonunion of humeral shaft fracture with dynamic compression plate and cancellous bone graft. J Chin Med Assoc. 2005; 68(2):73-6.

Gaillard J, Masquelet AC, Boutroux P, Cambon-Binder A. Induced-membrane treatment of refractory humeral non-union with or without bone defect. Orthop Traumatol Surg Res. 2020;106(5):803-811.

Wang SH, Chang JH, Pan RY, Chao KH, Lin LC, Wang SJ. Treatment of Osteopenic or Non-united Fractures of the Humerus with Structure Bone Allograft and Non-locking Plates. J Med Sci, 2013,33:67-74

Ilyas I, Younge DA. Locked intramedullary nailing for difficult nonunions of the humeral diaphysis. Int Orthop, 2003; 27: 278-281

Li XK, Wang HQ, Wei YY, Wu ZX. Treatment of nonunions of humeral fractures with interlocking intramedullary nailing. Chin J Traumatol. 2008;11(6):335-40.

Peters RM, Claessen FM, Doornberg JN, Kolovich GP, Diercks RL, van den Bekerom MP. Union rate after operative treatment of humeral shaft nonunion--A systematic review. Injury. 2015;46(12) :2314-24.

Hornicek FJ, Zych GA, Hutson JJ, Malinin TI. Salvage of humeral nonunion with onlay bone plate allograft augmentation. Clin Orthop Relat Res. 2001 May;(386):203-9.

Patel VR, Menon DK, Pool RD, Simonis RB. Nonunion of the humerus after failure of surgical management. J Bone Joint Surg Br. 2000; 82(7):977-83.

Gaillard J, Masquelet AC, Boutroux P, Cambon-Binder A. Induced-membrane treatment of refractory humeral non-union with or without bone defect. Orthop Traumatol Surg Res. 2020;106(5):803-811.

Downloads

Published

07-12-2022

How to Cite

1.
Basile G, Fozzato S, Bianco Prevot L, Accetta R, Petrucci QA. Refractory humeral non-union: treatment with photodynamic intramedullary implant IlluminOss® and internal fixation. Acta Biomed. 2022;93(S1):e2022340. doi:10.23750/abm.v93iS1.13773