Comparative study of bridging Tricoticocancellous bone graft post medullary canal recanalization versus classical bone graft without opening medullary canal both procedures were used dynamic compression plate fixation in treatment of non-uniting fracture shaft humerus

Background: Nonunion of a Humerus shaft fracture after conservative treatments or repeatedly failed surgical attempts bone healing a difficult therapeutic problem especially in the presence of osteoporosis, bone defect, and joint stiffness. We evaluated the treatment of nonunion of humeral shaft fracture with dynamic compression plate from June 2004 to December 2009 in Sulaimani Teaching Hospital, for healing of Nonunion fracture humerus. Aim of study: The lack of mechanical stability due to a flail arm functionally affected that interference with personal hygiene, dressing, and daily activities. The goal of surgery is to achieve a stable rigid fixation on healed nonunion fracture humerus, plus early mobilization. Methods: We evaluated the treatment of nonunion of humeral shaft fracture with dynamic compression plate from June 2004 to December 2009 in Sulaimani Teaching Hospital, for healing of nonunion humerus . 44 patients randomly collected, classified into two groups. Group A, 22 patients were treated by recanalization opening the medullary canal with bridging Tricoticocancellous bone graft. Group B 22 patients were treated by bone graft alone without opening the medullary canal. Both groups were using compression plate Fixation in treatment of Non-uniting fracture shaft humerus. Results: In group a, 22 patients age range 22-60 years (mean age 41years). There were 16 males and 6 females. Four patients had open fractures; (one due to explosion of a truck tire, second due to machine injury, and two dues to road traffic accidents). 8 patients had treated conservatively, 14 patients had previous surgical treatment in the form of open reduction and internal fixation using plates and screws, intramedullary nails of different types. 12 patients autogenous ICBG were used previously at least once time together with internal fixation. The mean duration of nonunion was 4 years between 2- 6 years. Group B, the mean age between 25-64 years (mean age 44.5 years). There were 18 males and 4 females' patients. Two patients had open fractures. 10 patients had treated conservatively, 12 patients had previous surgical treatment in the form of open reduction and internal fixation using plates and screws, intramedullary nails of different types. 10 patients autogenous ICBG were used previously at least once time together with internal fixation. The mean duration of nonunion was 4.5 year between 3- 6 years. We detected improvements in our study for both bone healing index results and functional index outcome. The bone results were evaluated by the union rate, angular deformity, and limb shortening. The functional outcomes were evaluated for pain, function, movement, muscle power, and patients satisfaction. Conclusion: We confirm that recanalization opening medullary canal plus three Tricoticocancellous bone graft are superior in healing of Non-uniting fracture humerus than without recanalization non-opening medullary canal. However, we used dynamic compression plating in both techniques.