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Orthobullets Trauma > Humeral Shaft Nonunion > Flashcards

Humeral Shaft Nonunion Flashcards

1
Q

what is humeral shaft nonunion?

A

characterized by the arrest of the fracture repair process of a humeral shaft fracture which may occur following nonoperative or operative management

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2
Q

characterized by the arrest of the fracture repair process of a humeral shaft fracture which may occur following nonoperative or operative management

A

humeral shaft nonunion

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3
Q

incidence of nonunion with nonoperative management

A

2 to 33%

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4
Q

incidence of nonunion with operative management

A

5-10%

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5
Q

_____ third humeral shaft fractures are felt to have higher rates of nonunion

A

proximal

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6
Q

biological risk factors

A

metabolic/endocrine abnormalities (osteoporosis, Vitamin D deficiency most common)
infection
patient factors (smoking, obesity, malnutrition, noncompliance)
open fracture

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7
Q

metabolic/endocrine abnormalities that increase risk for nonunion

A

osteoporosis
vitamin D deficiency

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8
Q

mechanical risk factors

A

unstable fracture patterns with inadequate stability
shoulder or elbow stiffness (motion directed to fracture site)

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9
Q

pathophysiology:

A

inadequate stability at fracture site with operative or nonoperative treatment

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10
Q

associated conditions

A

radial nerve palsy

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11
Q

____ vessel of humerus courses along the medial aspect of the mid to distal third of the diaphysis

A

nutrient

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12
Q

nutrient vessel of humerus courses along the ____ aspect of the mid to distal third of the diaphysis

A

medial

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13
Q

pectoralis major and ____ create strong deforming forces on proximal diaphyseal fractures

A

deltoid

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14
Q

_____ and deltoid create strong deforming forces on proximal diaphyseal fractures

A

pec major

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15
Q

_____ tendon interposition in proximal diaphyseal fractures may lead nonunion

A

biceps

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16
Q

biceps tendon interposition in proximal diaphyseal fractures may lead to _____

A

nonunion

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17
Q

physical exam:

A

assess the fit of functional brace and skin irritation
atrophy
angulation
motion
gross motion at the fracture site
neurovascular
assess radial nerve function

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18
Q

recommended radiographic views

A

AP and lateral of the humerus, shoulder, and elbow

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19
Q

radiographic findings

A

lack of fracture consolidation
hypertrophic callous formation
pseudarthrosis

20
Q

to evaluate for the extent of bridging callous and preoperative planning

A

CT

21
Q

CT indications

A

to evaluate for the extent of bridging callous and preoperative planning

22
Q

serum labs to order

A

CRP, ESR, CBC (must rule out infection)
total protein and serum albumin
vitamin D, TSH, PTH

23
Q

nonoperative treatment involves:

A

functional bracing +/- bone stimulation

24
Q

non op indications

A

rarely indicated unless low demand, high-risk surgical candidate, and asymptomatic nonunion

25
Q

nonunion over a period greater than 9 months or no progressive healing 3 months from injury indicates use of ___

A

bone stimulator

26
Q

bone stimulator indications

A

nonunion over a period greater than 9 months or no progressive healing 3 months from injury

27
Q

bone stimulator contraindications

A

contraindicated if pseudarthrosis, fracture gap >5mm, or poor blood supply

28
Q

contraindicated if pseudarthrosis, fracture gap >5mm, or poor blood supply

A

bone stimulator

29
Q

gold standard operative technique

A

compression plating with bone grafting

30
Q

operative options

A

compression plating with bone grafting
dual plating
cortical strut allograft/autograft
bone morphogenic proteins

31
Q

compression plating with bone grafting indications

A

symptomatic nonunion

32
Q

dual plating indications

A

very proximal or distal fracture nonunion
poor metaphyseal bone quality
micromotion noted at fracture site following single plate fixation

33
Q

very proximal or distal fracture nonunion
poor metaphyseal bone quality
micromotion noted at fracture site following single plate fixation

A

dual plating indications

34
Q

dual plating shows ____% union at 16 weeks

A

92-100

35
Q

cortical strut allograft/autograft indications

A

severe osteopenia from disuse, age, or prior surgery
severe bone loss
recalcitrant nonunion

36
Q

severe osteopenia from disuse, age, or prior surgery
severe bone loss
recalcitrant nonunion

A

cortical strut allograft/autograft

37
Q

bone morphogenic proteins indications

A

limited role as no studies show improved outcomes

38
Q

compression plating complications

A

radial nerve neuropraxia or injury
ICBG donor site morbidity

39
Q

compression plating instrumentation

A

4.5mm compression plate placed anterior, lateral, or posterior

40
Q

dual plating instrumentation

A

place additional plate orthogonal to the first plate

41
Q

cortical strut bone work

A

place strut intramedullary and then place the plate
place strut medially and place laterally based compression plate

42
Q

complications:

A

nerve injury
persistent nonunion

43
Q

most common nerve injury

A

radial

44
Q

treatment of persistent non union

A

free fibular grafting

45
Q

free fibular grafting indications

A

recalcitrant atrophic nonunions

46
Q

With operative treatment of nonunion, _____% of patients go on to union

A

83-100

Orthobullets Trauma (63 decks)

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