Humeral Nonunion ICD-10
Humeral Nonunion ICD-9
- 733.82 (nonunion of fracture)
Humeral Nonunion Etiology / Epidemiology / Natural History
- Nonunion = no improvement clinically or radiologically in fracture healing over a 3 month period.
- @10% of Humeral shaft fractures result in nonunion with both operative and non-operative treatment.
Humeral Nonunion Anatomy
- Musculocutaneous N pierces coracobrachialis 5-8cm distal to coracoid, supplies biceps,coracobrachialis & bracialis
- See also Arm anatomy.
Humeral Nonunion Clinical Evaluation
- Pain, swelling, deformity of arm.
- Crepitus and motion at fracture site.
- Document neurovascular exam, especially radial nerve.
Humeral Nonunion Xray / Diagnositc Tests
- A/P and lateral views of the humerus generally clearly demonstrate fracture.
- Consider shoulder and elbow films if there is any concern for intraarticular extension.
- MRI /CT generally not needed.
- Consider infection work-up, especially if previously treated with surgery.
Humeral Nonunion Classification / Treatment
- Atrophic: Humeral Shaft ORIF with ICBG (Ring D, JBJS 2000;82Br:867) or DBM (Hierholzer C, JBJS 2006;88A:1442).
- HypertrophicHumeral Shaft ORIF:
- Atrophic with prior failed fixation and bone grafting: Humeral Shaft ORIF with fresh frozen allograft or autograft intramedullary fibular grafting. (Jupiter JB, JBJS 1990;72A:701).
- Radial nerve palsy: exploration of radial nerve palsy in closed fractures is not recommended. Radial nerve transection is associated with open fractures, but direct repair has not shown good functional outcomes. (RingD, J Hand Surg 2004;29A:144).
Humeral Nonunion Associated Injuries / Differential Diagnosis
- Radial nerve palsy
- Infection / osteomyelitis
Humeral Nonunion Complications
- Delayed union = failure to unite in 2-3 months
- nonunion 4-6 months
- malunion, nonunion, vascular, radial N(10%),
- Radial nerve palsy-most recover in 3-4 months, pts should be placed in cock-up wrist splint, given thumb abduction and finger/wrist extension exercises to avoid contracture. EMG at 6 wks if no signs of recovery. Brachioradialis should be first muscle to return. 11.1% of closed fx have associated Radial nerve palsy, 0.2% in closed fx's fail to recover. 18% open fx. 60% have nerve entrapped in fx. (Bostman O, Acta Orthop Scand 1986;57:316) . (Shaz JJ, Bhatti NA: CORR 1983;172:171. (Holstein A JBJS 1963;458:1382).
Humeral Nonunion Follow-up Care
Humeral Nonunion Review References
- Rockwood and Green's Fractures in Adults 6th ed, 2006