BACKGROUND:
This study evaluates the clinical and functional outcomes of intramedullary nailing without grafting for the treatment of aseptic humeral shaft nonunion.
METHODS:
Between January 2017 and January 2024, 14 patients treated at a single center for humeral shaft fractures diagnosed with nonunion and managed with intramedullary nailing without grafting were retrospectively analyzed. Demographic and clinical characteristics, union status, and preoperative and postoperative range of motion, Visual Analog Scale (VAS), QuickDASH, and Constant-Murley scores were recorded.
RESULTS:
The study included 14 patients (9 women, 5 men) with a mean age of 49.2 ± 17.5 years (range, 26–80). Nonunion types were oligotrophic in 64.3% (n=9), atrophic in 28.6% (n=4), and hypertrophic in 7.1% (n=1) of cases. The union rate after intramedullary nailing without grafting was 78.5% (11/14). Two patients who did not achieve union underwent nail exchange with iliac autograft, resulting in a total union rate of 92.9% (13/14). Mean union time was 4.3 ± 2.8 months (range, 2–12). The mean preoperative and postoperative QuickDASH scores were 89.4±6.2 and 17.5±13.3, and Visual Analog Scale (VAS) scores were 7.7±1.1 and 1.7±1.1, respectively (p < 0.001). The nonunion type of 2 patients who failed to union after initial treatment was atrophic nonunion and one was oligotrophic nonunion. A statistically significant difference in nonunion type was observed according to revisions (p<0.01), with atrophic nonunions being significantly higher in cases requiring revision. One patient developed adhesive capsulitis, and another patient who underwent revision experienced transient radial nerve palsy with complete functional recovery. Proximal screw loosening was observed in two patients and recorded as a minor complication.
CONCLUSÝON:
Intramedullary nailing without grafting is an effective and safe treatment for aseptic humeral shaft nonunion in selected patients, particularly those with prior conservative treatment. However, omitting grafting in atrophic nonunion or nail exchange cases may negatively impact healing.

Keywords: Humerus fracture, intramedullary nailing, nonunion, pseudoarthrosis, graft

Aseptik humerus þaft kaynamama tedavisinde alternatif bir yöntem: Greftsiz Ýntramedüller çivileme

AMAÇ:
Bu çalýþma, aseptik humerus cisim psödoartrozu tedavisinde greftsiz intramedüller çivilemenin klinik ve fonksiyonel sonuçlarýný deðerlendirmektedir.
GEREÇ VE YÖNTEM:
Ocak 2017 – Ocak 2024 tarihleri arasýnda, tek merkezde humerus cisim kýrýðý nedeniyle psödoartroz tanýsý almýþ ve greftsiz intramedüller çivileme ile tedavi edilmiþ 14 hasta retrospektif olarak incelendi. Demografik ve klinik özellikler, kaynama durumu, ameliyat öncesi ve sonrasý eklem hareket açýklýðý, Görsel Analog Skala (VAS), QuickDASH ve Constant-Murley skorlarý kaydedildi.
BULGULAR:
Çalýþmaya yaþ ortalamasý 49,2 ± 17,5 yýl (26–80) olan 14 hasta (9 kadýn, 5 erkek) dahil edildi. Psödoartroz tipleri olgularýn %64,3’ünde (n=9) oligotrofik, %28,6’sýnda (n=4) atrofik, %7,1’inde (n=1) hipertrofik olarak saptandý. Greftsiz intramedüller çivileme sonrasý kaynama oraný %78,5 (11/14) idi. Kaynama saðlanamayan 2 olguya iliak otogreft ile çivi deðiþimi uygulandý ve toplam kaynama oraný %92,9’a (13/14) ulaþtý. Ortalama kaynama süresi 4,3 ± 2,8 ay (2–12 ay) idi. Ameliyat öncesi ve sonrasý QuickDASH skorlarý sýrasýyla 89,4±6,2 ve 17,5±13,3; VAS skorlarý ise 7,7±1,1 ve 1,7±1,1 bulundu (p < 0,001). Ýlk tedavi sonrasý kaynamayan 2 olgunun psödoartroz tipi atrofik, birinin ise oligotrofikti. Revizyon gerektiren olgularda atrofik psödoartroz oraný anlamlý derecede yüksek bulundu (p<0,01). Bir hastada adeziv kapsülit geliþti, revizyon uygulanan baþka bir hastada ise geçici radial sinir felci gözlendi ve tam fonksiyonel iyileþme saðlandý. Ýki hastada proksimal vida gevþemesi minör komplikasyon olarak kaydedildi.
SONUÇ:
Greftsiz intramedüller çivileme, özellikle daha önce konservatif tedavi uygulanmýþ seçilmiþ hastalarda aseptik humerus cisim psödoartrozu için etkili ve güvenli bir tedavi seçeneðidir. Ancak atrofik psödoartroz veya çivi deðiþimi gereken olgularda greft kullanýlmamasý iyileþme sürecini olumsuz etkileyebilir.

Anahtar Kelimeler: Humerus kýrýðý, intramedüller çivileme, kaynamama, psödoartroz, greft