Non-Union of the Humerus

My mother is 66 yrs old and she had a slip and fall and year ago. The bone between her elbow and shoulder was broken and she was operated twice. The first doctor put the rod and plates with screws but that tend to reduce the nerve movement in her wrist and had to be operated the 2nd time. The 2nd doctor removed the plates and screws and did a bone grafting (taking out bone from the waist). Everything went fine but out of 4 support bones (sorry don’t know much about this), one did not join fine and she cannot function fully due to that. We took advice from multiple doctors and there are 2 suggestions: Either go fo another bone grafting or fit a plate. We are confused and we do not want multiple surgeries. Any piece of suggestion or advice is appreciated. I can send her x-rays and other medical repots on email if that would help in any way.

You do not say whether the bone graft was at the upper or lower end of the bone (there are two residual breaks apparent)

A problem currently is that the bone ends are being held apart by the intermedullary rod, and the screws above and below. The lower screw is surrounded by a “lucency” which could be an indicator of infection.

My approach would be to take out both sets of screws (top and bottom). The bone will shorten slightly, which at this stage is irrelevant. The rod should be left in to provide the necessary splinting.

It might be that as the ends of the bones get close to one another, the bone will unite spontaneously. On the other hand, even without uniting, your mother might be, and function, fine with the intermedullary nail as a splint.

The problem with bone grafting now is that there is potential infection. Also, the radial nerve is close to the fracture site, and there is likely to be significant scar obscuring the anatomy and making the procedure more hazardous.

Please ensure that your mother is not deficient of vitamin D, and has adequate other micro-nutrients

2 Responses

  1. I wouls agree that screw removal seems like a good option. I might add a stat gram stain feom several sources around the lucency. If infection is noted, then evacuation of the infection followed by antibiotic impregnated bead insertion may be a good idea.

    • There are a number of approaches to the diagnosis and management of infections of bone. Not all were laboured in this post, but some comments are posted elsewhere on the site.
      As always, diagnosis is the imperative first step. The screw, when removed, can be placed in a sterile container pending culture. At times it might help to insert a small catheter through the vacant screw hole into the depths of the wound to aspirate fluid or pus.
      A small amount of saline can be used to flush if direct aspiration is not possible.
      Full bacteriological studies are recommended, including the gram negative and anaerobic studies.
      Base line inflammatory markers have usefulness, and the opportunity should be used to assess the white and other cell counts.

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