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Allograft, autograft equally effective for humeral shaft fracture nonunion

Both groups showed similar results for shoulder function and performance, although allograft patients had better elbow function.

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Demineralized bone matrix is as effective as autologous bone graft for treating patients with nonunion or delayed union of humeral shaft fractures, a retrospective study shows.

Christian Hierholzer, MD, and colleagues at the Hospital for Special Surgery, New York, reviewed their experience treating such fracture patients using either autologous iliac crest bone graft or the demineralized bone matrix product (DBM) Grafton DBM Flex (Osteotech). The researchers sought to determine whether there was a difference in union rates between the two treatment approaches.

The study included 45 autograft-treated patients with a mean age of 50 years and 33 DBM allograft-treated patients with a mean age of 59 years. Thirteen (39%) autograft patients and 15 (45%) allograft patients had delayed union; 32 (71%) autograft patients and 18 (55%) allograft patients had nonunion.

All patients underwent a standardized surgical procedure involving open reduction and plate-and-screw fixation, according to the study, published in the American edition of The Journal of Bone and Joint Surgery.

The researchers found that all 45 (100%) autograft patients had achieved union by 4.5 months’ follow-up, and 32 of the 33 (97%) allograft patients had achieved union by 4.2 months’ follow-up.

The authors noted that there was a 44% overall morbidity rate among autograft patients associated with graft harvest. But both groups showed similar improvements in Constant and Murley-measured shoulder function. Excellent results were seen in 33 (73%) autograft patients and 24 (73%) allograft patients, while 10 (22%) autograft patients and nine (27%) allograft patients achieved good results.

However, significant differences were noted between groups in Mayo Clinic Performance Index score, with allograft patients having a better average result. For performance, 29 (64%) autograft patients and 28 (85%) allograft patients achieved an excellent result; 15 (33%) autograft patients and four (12%) allograft patients achieved a good result (P=.04), according to the study.

For more information:

• Hierholzer C, Sama D, Toro JB, et al. Plate fixation of ununited humeral shaft fractures: Effect of type of bone graft on healing. J Bone Joint Surg Am. 2006;88:1442-1447.