Outcomes of antegrade straight interlocking intramedullary nail combined with autogenous iliac crest bone graft in the treatment of nonunions of humeral surgical neck fractures at a minimum 2 years' follow-up.

ObjectiveNonunions of humeral surgical neck fractures (HSNF) are rare and complex problems. This study aimed to evaluate the clinical and functional outcomes of antegrade straight interlocking intramedullary nail (ASIIN) combined with autogenous iliac crest bone graft (ICBG) for treating nonunions of HSNF and to analyze the impact of initial treatment on nonunion repair outcomes.MethodsWe conducted a retrospective analysis of patients with nonunions of HSNF treated with ASIIN combined with autogenous ICBG at our institution. Patients were divided into two groups based on initial treatment: primary nonunion group or secondary revision of internal fixation group. All patients were followed up for a minimum of 2 years. Outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) pain score, and shoulder range of motion (ROM). Statistical analyses were performed to compare outcomes before and after nonunion repair and between the two groups.ResultsBetween June 2014 and May 2022, 29 patients with HSNF nonunions treated with ASIIN combined with autogenous ICBG were included in the study. The cohort comprised 11 patients initially treated conservatively and 18 patients who initially underwent locking plate fixation. Union was achieved in all patients at a mean of 5.6 months post-repair. At the final follow-up, significant improvements were observed in mean ASES scores, VAS pain scores, and active shoulder ROM compared to preoperative values. However, no significant differences were noted between the two groups. The mean union time was significantly shorter in the primary nonunion group.ConclusionASIIN combined with autogenous ICBG provides stable fixation and an active biological environment, offering an effective treatment for complex HSNF nonunions. Although initial treatment modality did not significantly affect clinical outcomes, patients initially treated conservatively achieved union faster than those treated surgically.