Fracture of shaft of humerus is very amenable to treatment but a percentage of fractures do not heal. Normal healing of a humeral fracture occurs over 8 to 10 weeks. If the fracture has not achieved union by 3 to 4 months, it can be considered a delayed union. If union does not occur by 6 to 8 months it is called non union of the fracture.
Non unions are two types
- Hypertrophic
- Atrophic
Hypertrohic occurs due to increased vascularity which allows abundant callus to form. The callus formed has insufficient stability to prevents union.
In atrophic non unions, the fracture has inadequate blood supply and prevents callus.
Operative treatment methods have higher rate of non union as compared to non operative method. Apart from this there are various factors that increase the chance whether a patient would develop non union. These factors are
- Inadequate immobilization
- Distraction at the fracture site resulting in a gap between fractured surfaces
- Energy of the injury
- Open fractures
Treatment
Treatment of the non union aims at removal of the cause if known, fixation of the fracture with surgery and bone grafting to augment the healing process.
The bone can be fixed by plating or intramedullary nailing. The graft is usually taken from iliac crest.
In caes of non union and osteoporosis, it might be difficult to attain the fixation. In such cases an additional procedure like filling he cabity with cement or augumentation with fibula may be needed
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About Dr Arun Pal Singh
4 months back i had an accident in which my arm bone got broken so i had consulted many doctors they all said that plate surgery wud be required so after couple of days i went-off for a surgery and after that doc. told me to keep the plaster for a month(not to take any risk)after a month they said the bone has started healing so he removed it and told me to come for physiotherepy and after few days i started moving my hand it was completely no pain but i didnt know i wud have to suffer a lot of pain after it and i met doctor after it they had my x ray and it shows the mis alignment i completly shocked to see the plate is coming out of the bone so he told me to keep a belt on ur arm for few wek as i did tht. after it i got my plate back into the bone and he told me to keep the plaster again,i did that but healing doesnt work i met some doctors now each have thier different opinion someone says that bone grafting wud be needed someone says it is due to infection and another says to wait 4 some more time but i know how painful it is n i feels very dependent what steps i should take now?
Dr Arun Pal Singh Reply:
April 30th, 2010 at 10:24 am
@aman,
You did not mention which bone it was but I presume it is humerus.
Could you mail me an xray.
Hi Sir
I had a fracture on my shaft of humerus, left arm. An xray was taken after after 2 months of operation (plate and screws), the gap was seen to be filling. The doc advised me to start straightening my arm. I use a plastic arm support. After one more month, the xray showed the gap was back again with the bridge bones missing. The plates havent changed shape. Its been total 3 months now. I also have lecithin and minoxidil simultaneously. There was also an incident where my hand got jerked recently when i was not wearing the plastic support. There is still pain when the spot is pressed. Please suggest steps i should take. Are there any electronic stimulators? What could be the reason of this reappearence of gap.
Tapojoy
Dr Arun Pal Singh Reply:
May 21st, 2010 at 8:18 am
@Tapojoy,
Ultrasonic stimulators are available but the effectiveness has varied and would depend on the gap between the fracture fragments.
i hav a humerous fracture left arm near bicep so healing is very slow what precautions i should take and which is the best medicine or powder for calcium and give me some tips that how healing can occur quickly
Dr Arun Pal Singh Reply:
July 4th, 2010 at 7:01 am
@aman,
You should eat good diet and follow your treating doctor’s advice.
Calcium is only of less significance and quest for the best will not yeild anything.
Hi I have found this article very helpful I am basically looking for evidence that sometimes these processes do take place. I had/have a complex spiral fracture of the tib, and the op of the tib was snapped off and in half vertically, the operation was delayed by two weeks due to cast blisters over my whole lower leg, then I was readmitted with an infection actually 4 now, I have had 10 or so wash out operations over 5 weeks and now a plastics operation of a skin flap over the metal work and skin grafts now over the calf and shin, and I have had another x ray showing “no evidence of bone union” I have a metal plate running the length of my leg and about 14 screws, 5 holding my knee together the rest running down the tib. this has nearly been 3 months since the original accident. I am hoping that the reason for the lack of bone union is the repeated operations. The medical staff still appear upbeat about it whereas I am getting paranoid that they will remove my leg. The infections include pseudo monas which has become resistant to both cypro and gentamysin and is now being treated with tazocin.
I assume everything is as good as it could be in the circumstances.
Thanks for any input or advice
Dr Arun Pal Singh Reply:
August 13th, 2010 at 3:48 pm
@stuart,
Non union is a problem and infected non union is a bigger problem. But both can be managed with proper treatment.
In case of infected non union, the idea is to eliminate the infection first and then stimulate the bone healing.
I think you are on right track. Please do keep me posted.
I broke my humerus (mid-shaft) in April. and at first they said they were going to operate but then decided to send me home with an airplane cast. My follow-up ortho removed the cast a week later and put on a brace, but 10 weeks later he said it wasn’t healing and recommended ORIF. He put in a plate and pins that extend the lenght of my humerus. Since my surgery I have had shoulder pain, and now 8 weeks after surgery I still can not extend my arm to the side more than 30 degrees without my entire shoulder raising 3 to 4 inches abnormally in comparison to my good arm. I am experiencing pain in my should and across my back and neck. PT does not seem to be helping. What should I do?
Dr Arun Pal Singh Reply:
September 2nd, 2010 at 5:41 am
@Joan,
What is status of bone union? What did your doctor suggest?
Prolonged immobilization lead to joint stiffness that is generally amenable to PT.
But we must ensure that fracture has united.