Vol. 5, Issue 1, Part A (2023)

Introduction: The non-union is one of the most feared late complications in the treatment of fractures of the humeral shaft. The repeated failures of cures for pseudarthrosis of the humeral shaft define multi-operated pseudarthrosis also called Intractable Pseudarthrosis of Humeral Shaft (IPHS) or recalcitrant pseudarthrosis. The treatment of these IPSH requires beyond the cure of pseudarthrosis the management of bone reconstruction.
Goal: The hypothesis of this work is that the use of the non-vascularized fubular (NVF) technique with a dynamic fixation in compression by DCP plate allowed to obten a consolidation in the treatment of rebellious pseudarthrosis of the humeral shaft.
Material and Methods: It was a prospective, in single-center and single-operator study carried out at Afagnan hospital from December 2018 to December 2020 on 10 cases of IPHS. The NVF technique with dynamic and compressive fixation by DCP screwed by 4.5mm screws was performed in all patients.
Results: The mean age of the patients was 44 years with extremes ranging from 25 years to 54 years. The average number of history of nonunion cure failure was 1.4. All Pseudarthrosis was aseptic, atrophic, with osteopenia and bone lysis.
The mean size of the bone defect was 8.9 cm and the mean size of NVF removed was 11.4 cm. The radial nerve was transposed in 6 cases with 5 cases of iatrogenic motor involvement of the radial nerve. The evolution was favorable after 3 months.
The mean operative delay of IPHS was 2h55mn. The Consolidation was achieved in all patients. The average delay of consolidation of 7.8 months. All patients have resumed their former activities.
Conclusion: The challenge of patients with IPHS is the bone consolidation and the lost bone reconstruction. The NVF technique with dynamic and compressive DCP plate gives satisfactory anatomical and functional results in the management of multi-operated non-union.