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Trauma
Humeral Non-unions Treated Successfully with Internal
Fixation and Demineralized Bone Matrix
James A. Tom, MD, Susan P. Harding, MD, Joshua M. Abzug, MD, Douglas
L. Cerynik, MD
 Introduction
Non-unions of the humeral shaft are not an uncommon complication,
but one that can be technically difficult to treat.1 Anatomic
reduction and adequate fixation are sometimes not sufficient
to stimulate osteoinduction and callus formation.2 The placement
of malleable bone grafting substitutes containing demineralized
bone matrix (DBM) at the non-union site, in combination with
proper fixation techniques, has led to successful unions similar
to those seen using iliac crest bone grafting without the
associated morbidity.
We present two patients with traumatic fractures of the humeral
shaft who developed non-unions after initial open reduction
and internal fixation (ORIF), both of whom subsequently went
on to full healing after repeat ORIF with placement of DBM
graft material at the site of non-union.
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Case Reviews
Case 1
A 72-year-old female presented with a non-union of a right transverse
mid-shaft humerus fracture that had undergone ORIF 11 weeks previously.
Initial preoperative radiographs of the humerus demonstrate this
non-union after initial plating.
The patient subsequently underwent revision ORIF of the right humerus
with a plate reduction and placement of Accell Total Bone Matrix®
(IsoTis OrthoBiologics, Inc., Irvine, CA) at the site of the non-union.
This went on to full union of the fracture.
Case 2
A 59-year-old female reportedly sustained a right humeral fracture
7 years ago that was treated by open reduction and internal fixation
(ORIF). She presented to our hospital after a recent fall. Her radiographs
demonstrated a non-union of the original ORIF and a new fracture
distal to the plate.
The patient underwent revision ORIF of the right humerus with Accell
Total Bone Matrix® placed at the non-union and old screw hole
sites. This fracture went on to full union without further complication.
Results
The use of a malleable, osteoinductive, DBM-based bone graft substitute
at the site of humeral shaft non-unions has been shown to be a successful
treatment adjunct for the clinician. Short-term radiographic evidence
of callous formation and bony healing at the site of these prior
non-unions has been seen.
Reference
1. Rubel IF, Kloen P, Campbell D, Schwartz M, Liew A, Myers E, Helfet
DL: Open reduction and internal fixation of humeral nonunions: A
biomechanical and clinical study. J Bone Joint Surg Am 2002;84:1315-1322.
2. Crosby LA, Norris BL, Dao KD, McGuire MH: Humeral shaft nonunions
treated with fibular allograft and compression plating. Am J Orthop
2000;29:45-7.
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