Nonunions of the Humeral Shaft: Open Reduction Plate Fixation and Autologous Bone Graft Augmentation

  • Nikolaos K. Kanakaris
  • Fragkiskos N. Xypnitos
  • Peter V. Giannoudis


  • The incidence of humeral nonunions ranges from 2% to 10% (literature of initial nonoperative treatment of humeral fractures) to 12–15% (literature of initial operative treatment of humeral fractures).

  • Associated risk factors are:
    • The severity of the initial injury

    • Open fractures

    • Bone loss

    • Transverse fracture patterns

    • Distraction at the fracture site

    • Soft tissue interposition

    • Infection

    • Inadequate immobilization

    • Obesity or large body habitus

    • Osteoporosis

    • Alcoholism

    • Smoking

    • Malnutrition

    • Noncompliance to management plan

  • The vast majority of humeral nonunions require operative management to relieve instability, pain, and disability of the extremity.

  • Their treatment differs from that of acute fractures as it often requires intrafocal debridement of the nonunion site, and the operation is often complicated by the presence of hardware (plate or nail), bone loss, or infection.

  • Nonunion can be classified as hypertrophic or oligo/atrophic, septic or non-septic, and with or without the presence of hardware. It is imperative that all such cases are carefully assessed and the management plan carefully set by an experienced, in such cases, orthopedic team.


Radial Nerve Humeral Fracture Humeral Shaft Humeral Shaft Fracture Nonunion Site 
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Further Reading

  1. Rubel IF, 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-A:1315–22.PubMedGoogle Scholar
  2. Pugh DM, McKee MD. Advances in the management of humeral nonunion. J Am Acad Orthop Surg. 2003;11:48–59.PubMedGoogle Scholar
  3. Hierholzer C, Sama D, Toro JB, et al. Plate fixation of ununited humeral shaft fractures: effect of type of bone graft on healing. J Bone Joint Surg Am. 2006;88:1442–7.PubMedCrossRefGoogle Scholar
  4. Kanakaris NK, Giannoudis PV. The health economics of the treatment of long-bone non-unions. Injury. 2007;38 Suppl 2:S77–84.PubMedCrossRefGoogle Scholar
  5. Brennan ML, Taitsman LA, Barei DP, et al. Shortening osteotomy and compression plating for atrophic humeral nonunions:surgical technique. J Orthop Trauma. 2008;22:643–7.PubMedCrossRefGoogle Scholar
  6. Giannoudis PV, Kanakaris NK, Dimitriou R, et al. The synergistic effect of autograft and BMP-7 in the treatment of atrophic nonunions. Clin Orthop Relat Res. 2009;467:3239–48.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  • Nikolaos K. Kanakaris
    • 1
  • Fragkiskos N. Xypnitos
    • 2
  • Peter V. Giannoudis
    • 3
  1. 1.Department of Trauma and Orthopaedic SurgeryLeeds Teaching Hospitals NHS TrustLeedsUK
  2. 2.Department of Trauma and OrthopaedicsLeeds Teaching Hospitals NHS TrustLeedsUK
  3. 3.Academic Department of Trauma and Orthopaedic Surgery, School of MedicineUniversity of LeedsLeedsUK

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