Plate fixation of ununited humeral shaft fractures: effect of type of bone graft on healing

Background: Delayed union or nonunion of a fracture of the humerus is an infrequent but debilitating complication. Open reduction and internal fixation combined with autologous bone-grafting can result in reliable healing of the frac-ture; however, there is morbidity associated with the bone-graft donor site. This study was designed to evaluate heal-ing of ununited fractures of the humeral shaft treated by one surgeon at one institution with a strict and consistent surgical protocol but with the use of two different types of bone graft: autologous iliac crest bone graft and deminer-alized bone matrix. Methods: A consecutive retrospective cohort series was analyzed. From 1992 to 1999, forty-five patients with an asep-tic, atrophic delayed union or nonunion of a humeral shaft fracture were treated with open reduction and internal fixation with a plate and autologous iliac crest bone graft. The mean time from the fracture to the surgery was 14.0 months, and the mean duration of follow-up was 32.8 months. From 2000 to 2003, thirty-three patients with the same condition were treated with the same protocol with the exception that demineralized bone matrix was used instead of autologous iliac crest bone graft. The mean time from the fracture to the surgery in that group was 22.6 months, and the mean du-ration of follow-up was 20.4 months. All patients in both groups were assessed clinically and radiographically. Results: Osseous union was noted clinically and radiographically following the index surgery in 100 % of the forty-five patients treated with autologous bone graft and 97 % (thirty-two) of the thirty-three patients treated with demineralize