Double-plate fixation vs locking compression plate anchored monocortical autogenous iliac bone graft in the treatment of humeral shaft nonunion: a retrospective analysis

Abstract Background Humeral shaft nonunion is a challenging problem in orthopedic trauma. There is controversy regarding the choice between double-plate fixation and locking plate combined with structural bone grafting in the treatment of humeral shaft nonunion. This study aims to retrospectively compare the clinical advantages of double-plate fixation with autogenous iliac cancellous bone grafting (DPF group) versus locking compression plate anchored monocortical autogenous iliac bone and cancellous bone grafting (LCP + MAI group) in the treatment of humeral shaft nonunion. Patients and methods A total of 27 patients (10 females, 17 males) with closed, aseptic humeral shaft nonunion underwent revision surgery. The patients ranged in age from 29 to 55 years (mean 48 years). Fourteen patients were treated with double-plate fixation combined with autogenous iliac cancellous bone grafting (DPF group), and 13 patients were treated with locking compression plate fixation combined with monocortical autogenous iliac strut and cancellous bone grafting (LCP + MAI group). Operative time, intraoperative fluoroscopy frequency, fracture healing time, full weight-bearing time, and Disabilities of the Arm, Shoulder and Hand (DASH) scores of preoperative, 6-month and 12-month postoperative were collected for both groups. Direct medical costs of the two groups were also extracted from the hospital billing database and analyzed. Results Fracture healing was achieved in all patients in both groups. Operative time in the LCP + MAI group was 113.0 (IQR, 107.0-128.0) min, significantly shorter than 132.5(IQR,122.0-147.0) min in the DPF group ( P <0.01). The number of intraoperative fluoroscopy exposures was 6.0 (IQR,6.0-6.0) in the LCP + MAI group, significantly lower than 8.0 (IQR,6.0-8.0) in the DPF group ( P <0.05). No statistically significant differences were observed between the DPF and LCP + MAI groups in full weight-bearing time ( p >0.05) or fracture healing time ( p >0.05). There were no significant differences in preoperative DASH scores, DASH scores of 6-month and 12-month postoperative between the two groups ( p >0.05). In the DPF group, the DASH scores improved significantly from 73.0 (IQR, 72.0-74.0) preoperatively to 30.5 (IQR, 29.0-32.0) at the 6-month follow-up and to 19.0 (IQR,18.0-20.0) at the 12-month follow-up ( p <0.001). In the LCP + MAI group, DASH scores improved significantly from 74.0 (IQR,73.0-74.0) preoperatively to 31.0 (IQR,31.0-34.0) at the 6-month follow-up and to 19.0 (IQR, 18.0-20.0) at the 12-month follow-up ( p <0.001). Medical costs analysis of the two treatment modalities demonstrated that Hardware costs (USD 3894.79 [2277.31, 4068.27] vs. 1672.62 [1453.20, 2332.89], p < 0.001), In-hospital costs (USD 7283.20±1183.27 vs. 4935.62±821.97, p < 0.001), and Total medical costs (USD 7476.65±1177.86 vs. 5124.50±5523.6, p < 0.001) were significantly higher in DPF group than in LCP + MAI group. Conclusion The LCP + MAI technique offers comparable clinical efficacy to DPF, while demonstrating advantages in operative efficiency (shorter surgical time and fewer fluoroscopic exposures) and cost-effectiveness (lower total medical costs).