Treatment of recalcitrating pseudoarthrosis of the humeral diaphysis by fixing with dynamic compression plate and dynamic muller frame plus autologous oseo graft.

Abstract

The purpose of this article is to show the efficacy in the treatment of a humerus nonunion by applying a DCP plate (Dynamic Compression Plate) plus autologous bone graft.

Introduction: Pseudoarthrosis is a process in which the ability to consolidate the fracture disappears due to the failure of osteogenesis, this is a definitive and irreversible process. It is estimated that 3-8% of all fractures in the human body correspond to the shaft of the humerus. Despite applying adequate treatment, a significant percentage of these fractures will progress to pseudarthrosis. Its incidence varies between 2–10% in fractures treated conservatively and can reach 10–15% when treated by surgery. It is currently one of the most challenging complications for orthopedic surgeons.

Clinical case: we present a 50-year-old male patient with no health history who, after surgical resolution of a humeral shaft fracture, suffers two episodes of trauma to the same limb that cause fatigue of the osteosynthesis material and subsequent pseudoarthrosis.

Surgical technique: a pseudoarthrosic focus is approached, bone fragments are regularized, a dynamic compression plate is placed plus an autograft of the iliac crest with Müller's cerclage.

Results: after four months postoperatively, consolidation of the fracture and acceptable functional capacity were evidenced on physical examination.

Discussion: access to the nonunion site, cleaning the interposing fibrous tissue and the systematic use of long dynamic compression plates (DCP) with autologous bone graft, has been reported in the literature with consolidation rates of 98%.

Conclusions: the application of a compression plate plus autologous bone graft in the treatment of pseudarthrosis of the diaphysis of the humerus is the most effective option and is considered the surgical technique of choice.