A New Treatment for Nonunion of the Proximal Humerus in the Elderly

A core Fixation

Abstract

Treatment of a fractured proximal humerus in the elderly often encounter difficulties, including nonunion, bone absorption and severe osteoporosis. The treatment of such a case with severe osteoporosis has been challenged. Such a fragile humerus shaft can not be fixed firmly with a plate and nails. We wish to report on a new method of core fixation for such cases of nonunion of the proximal humerus, using a fibula graft as the intramedullary rod. Four women (ave.66 years old) were operated on with the core fixation method. The mean period from initial fracture to operation was 145 days. All were diagnosed as a neck fracture of the humerus and treated conservatively. A fibula graft was inserted intramedullary into the humeral shaft and head as a core (core fixation). First, the supplemental fixation between the graft and the humeral head was provided by a No.20 stainless steel wire. Next, a hook plate and nails were penetrated toward the core. Thereby, a firm fixation was obtained between the shaft and the head in nonunion cases. The average postoperative JOA score was 80.0 points. ROMs of those shoulders were excellent or good in 4 months after operation in all cases. Bone union was completed and there were no residual complaints in any of the cases. A core fixation was useful as a preferred method in the nonunion of proximal humeral fractures with severe osteoporosis in the elderly.