Simple Approach to the Management of Aseptic Non-union of the Shaft of Long Bones

AS Devnani
Correspondence: Dr A S Devnani, devnani@kb.usm.my

ABSTRACT
Aim Internal fixation with a plate in the management of non-union for shaft of long bones has been condemned but the review of the literature does not provide such unequivocal evidence. Also there are certain situations where it is either technically not feasible or contraindicated to do closed intramedullary nailing. This study was done to see the outcome of plate-fixation for the treatment of non-union of the shaft of long bones.
Method The non-union was treated by freshening the fracture ends, opening the medullary canal, re-aligning and stabilizing the fracture with a plate and packing autogenous cancellous bone grafts around the non-union site. There were 25 patients with an average age of 35 years. The non-union involved 7 femurs, 8 humerii and 10 tibiae. The initial treatment was operative in 11 patients, by plaster cast in 5, by traction in 1 and by traditional practitioner in 8. There was no pathological fractures or infected cases. The average delay prior to operation was 14 months and the average follow up was 30 months.
Results All non-unions healed on an average in 18 weeks. There was neither incidence of infection nor any complications at the bone graft donor site. Three cases of transient nerve paralysis recovered spontaneously. One femoral plate broke at 12 weeks, which required replating. In another patient the distal screws of the femoral plate pulled out, this was managed successfully with a cast brace.
Conclusion Plate fixation is useful and effective in the management of non-union, more so in situations where it is technically not feasible to do closed intramedullary nailing. The incidence of infection, success of union and time to union are comparable with other methods.

Keywords: aseptic non-union, shaft of long bones, plating and bone grafting
Singapore Med J 2001; 42(1): 20-25