Paper Title: Humeral Shaft Fracture Non-union with a Bone Gap: A Case Report
Authors: Diamond T.E, Echem R.C, Eyimina P.D
BACKGROUND: Fractures of the humeral shaft constitute 1-3% of all fractures. Non-union rates for open humeral fractures after optimal treatment range from 5-15% .Bone gaps commonly occur when high energy weapons are involved in the primary injury, when previous treatment was complicated by bone infections and when bone necrosis follows significant periosteal stripping from previous intervention. AIM: We report the management of humeral fracture non-union with a bone gap in a young adult. CASE SUMMARY: Mr. A.O, a 23 year old trader presented to us with deformity and abnormal motion across the right arm. He had gunshot injury to the right arm 6 months earlier during an inter-communal clash. Initial treatment was in a private hospital in his community and involved daily wound dressing, antibiotic prophylaxis and pain relief. He subsequently left the hospital 3weeks later (when wound healed) to a traditional bone setter place. At presentation to our clinic, he had features of a non-united right humeral shaft fracture with no radial nerve palsy. Plain radiograph showed a non-united fracture of the humeral shaft with a bone gap. There was no evidence of bone infection. He subsequently had open reduction and internal fixation using a narrow dynamic compression plate and screws. A core of 4cm cortico-cancellous bone graft was used to fill the gap. Radiographs by six weeks post-operative review showed good evidence of graft vascularity and bridging callus across fracture site. CONCLUSION: Cortico-cancellous bone grafts can be effectively used in the treatment of humeral shaft non-union with bone gap.