Management of a humeral shaft non-union after a Gustilo III C fracture. (December 2015)

• Record Type: Journal Article
• Authors: Conserva, Vito; Vicenti, Giovanni; Abate, Antonella; Pesce, Vito; Moretti, Biagio
• Is Part Of: Injury. Volume 46:Supplement 7(2015)
• Page Start: S11
• Page End: S16
• Publication Date: 2015-12
• Subjects: distal radius fractures -- external fixation -- open reduction internal fixation -- volar locking plates -- elderly patients; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/S0020-1383(15)30037-1
• Languages: English
• ISSNs: 0020-1383

Abstract

Abstract: A 25-year-old man was admitted to our Department with an open humeral shaft fracture (Gustilo III C); two large wounds were noticed with ulnar artery and median nerve completely dissected. Initial primary treatment included irrigation, debridement and fracture stabilization with a monolateral external fixator followed by vascular and nerve repair and wound closure. At 6 months follow up the patient was able to use his arm without any painful stimuli and a CT scan showed the presence of postero-medial callus formation. Consequently, the external fixator was removed and the patient was discharged to physiotherapy. After 7 months, the patient presented with severe pain and functional impairment with no history of trauma. X rays showed recent re-fracture on a background of oligotrophic nonunion. Revision surgery included debridement of the non-union bone edges, reaming of the medullary canal and insertion of a humeral nail. Six months later osseous healing was noted with complete restoration of shoulder and elbow movement and partial recovery of the median nerve.