OTA International (Mar 2025)
Factors associated with failure of humerus nonunion surgery in patients with initial nonoperative management
- Alexander Hysong, MD,
- Noah Harrison, MD,
- Samuel Posey, MD,
- Ziqing Yu, MS,
- Andrew T. Chen, MD,
- Patrick Pallitto, MD,
- Joseph R. Hsu, MD,
- William Obremskey, MD,
- Evidence-Based Musculoskeletal Injury and Trauma Collaborative (EMIT),
- Hassan Mir, MD,
- Roman M. Natoli, MD, PhD,
- Ishani Sharma, MD, MBA,
- Jenna Jones, Med,
- Luke A. Lopas, MD,
- Hassan Farooq, MD,
- Robert D. Zura, MD,
- Alexander Padovano, MD,
- Nathaniel Koutlas, MD,
- Steve Hemmerly, BS,
- Elsa Rodriguez, MD,
- Daniel E. Pereira, MD,
- Sharon Babcock, MD,
- Gabriel James Sowards, BS,
- Martha Holden, AAS, AA,
- Anna N. Miller, MD,
- Marc Schatz, MD,
- Jessica Rivera, MD, PhD,
- Katrina Bang, MD,
- Kamryn King, BS,
- Zachery Hong, BA,
- Jarrod Dumpe, MD,
- Gabriella Lea Stribling, BS,
- Merritt John Thompson, MD,
- Tracy Johns, MSN, RN-BC,
- Rachel Seymour, PhD,
- Susan Odum, PhD,
- Stephen Sims, MD,
- Olivia Rice, MD,
- Ainsley Bloomer, MD,
- Katheryn Peterson, BSPH,
- Amber Stanley, BSPH,
- Mario Cuadra, MD,
- Gisele Bailey, MS,
- Matthew Braswell, MD,
- Landon Bulloch, MD,
- William Haynes, MD,
- Josef Jolissaint, MD,
- Julia Mastracci, MD,
- Andrew Wohler, MD,
- Eddie Komie Afetse, BS, BA,
- Cara Girardi,
- Juliette Sweeney, BS,
- Benjamin Averkamp, MD,
- Meghan Wally, PhD,
- Madhav Karunakar, MD,
- Kevin Phelps, MD,
- Laurence Kempton, MD,
- Christine Churchill, MA, CCRP,
- David Macknet, MD,
- Hannah Pollock, BS,
- Rodney Arthur, MS,
- Samuel Cohen-Tanugi,
- Isaac Boateng,
- James Michael Ruth, BS,
- Joseph Michalski, MD,
- Anna Hemminger, BS,
- Kathryn Leighty,
- Mir Ibrahim Sajid, MD,
- Thea Lance, BA,
- William Hunter Waddell, MD,
- Andres Fidel Moreno Diaz, MD,
- Joseph Gutbrod, BS,
- Christopher G. Herbosa, BS
Affiliations
- Alexander Hysong, MD
- a Atrium Health Musculoskeletal Institute, Charlotte, NC
- Noah Harrison, MD
- a Atrium Health Musculoskeletal Institute, Charlotte, NC
- Samuel Posey, MD
- a Atrium Health Musculoskeletal Institute, Charlotte, NC
- Ziqing Yu, MS
- a Atrium Health Musculoskeletal Institute, Charlotte, NC
- Andrew T. Chen, MD
- b University of North Carolina, Chapel Hill, NC
- Patrick Pallitto, MD
- b University of North Carolina, Chapel Hill, NC
- Joseph R. Hsu, MD
- a Atrium Health Musculoskeletal Institute, Charlotte, NC
- William Obremskey, MD
- c Vanderbilt University Medical Center, Nashville, TN.
- Evidence-Based Musculoskeletal Injury and Trauma Collaborative (EMIT)
- Hassan Mir, MD
- Roman M. Natoli, MD, PhD
- Ishani Sharma, MD, MBA
- Jenna Jones, Med
- Luke A. Lopas, MD
- Hassan Farooq, MD
- Robert D. Zura, MD
- Alexander Padovano, MD
- Nathaniel Koutlas, MD
- Steve Hemmerly, BS
- Elsa Rodriguez, MD
- Daniel E. Pereira, MD
- Sharon Babcock, MD
- Gabriel James Sowards, BS
- Martha Holden, AAS, AA
- Anna N. Miller, MD
- Marc Schatz, MD
- Jessica Rivera, MD, PhD
- Katrina Bang, MD
- Kamryn King, BS
- Zachery Hong, BA
- Jarrod Dumpe, MD
- Gabriella Lea Stribling, BS
- Merritt John Thompson, MD
- Tracy Johns, MSN, RN-BC
- Rachel Seymour, PhD
- Susan Odum, PhD
- Stephen Sims, MD
- Olivia Rice, MD
- Ainsley Bloomer, MD
- Katheryn Peterson, BSPH
- Amber Stanley, BSPH
- Mario Cuadra, MD
- Gisele Bailey, MS
- Matthew Braswell, MD
- Landon Bulloch, MD
- William Haynes, MD
- Josef Jolissaint, MD
- Julia Mastracci, MD
- Andrew Wohler, MD
- Eddie Komie Afetse, BS, BA
- Cara Girardi
- Juliette Sweeney, BS
- Benjamin Averkamp, MD
- Meghan Wally, PhD
- Madhav Karunakar, MD
- Kevin Phelps, MD
- Laurence Kempton, MD
- Christine Churchill, MA, CCRP
- David Macknet, MD
- Hannah Pollock, BS
- Rodney Arthur, MS
- Samuel Cohen-Tanugi
- Isaac Boateng
- James Michael Ruth, BS
- Joseph Michalski, MD
- Anna Hemminger, BS
- Kathryn Leighty
- Mir Ibrahim Sajid, MD
- Thea Lance, BA
- William Hunter Waddell, MD
- Andres Fidel Moreno Diaz, MD
- Joseph Gutbrod, BS
- Christopher G. Herbosa, BS
- DOI
- https://doi.org/10.1097/OI9.0000000000000354
- Journal volume & issue
-
Vol. 8,
no. 1
Abstract
Abstract. Objectives:. To describe operative results after humerus nonunion surgery in patients whose initial humerus shaft fracture (OTA/AO code 12) was treated nonoperatively and to identify risk factors of nonunion surgery failure in the same population. Design:. Case series. Setting:. Nine academic level 1 trauma centers. Patients/Participants:. One hundred twenty patients with humerus nonunion whose initial fracture was treated nonoperatively. Intervention:. Operative treatment of humerus nonunions. Main Outcome Measurements:. Rate of recalcitrant nonunion after humerus nonunion surgery. Results:. Of 108 humerus nonunions, 26 (24.07%) failed to unite after nonunion surgery. Moreover, 34 patients (31.48%) experienced 1 or more postoperative complications. Multivariate analysis found that the use of bone graft or bone graft substitute was not associated with successful nonunion surgery (95% odds ratio confidence interval [CI] [0.67–5.3], P = 0.23). Tobacco use was associated with an increased risk of persistent nonunion (P = 0.0041). Postoperative complications (P = 0.0001) were also associated with an increased risk of persistent nonunion. Diabetes and open fracture were not associated with differences in the nonunion repair success rate. Conclusions:. As the largest and most generalizable to date, this multicenter study found that nearly 1 in 4 patients with a humeral nonunion after initial nonoperative management failed their nonunion surgical treatment. While postoperative complications were associated with recalcitrant nonunion, surgical adjuncts such as bone grafting and type did not seem to influence the success rate of nonunion surgery. Smoking is a modifiable risk factor suggesting that smoking cessation should be part of the intervention. These findings can be used to give patients and surgeons a realistic expectation of results and complications after humerus nonunion surgery. Level of Evidence:. Therapeutic level III.
