{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T19:28:45Z","timestamp":1790278125951,"version":"4.1.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n            <jats:title>OBJECTIVES:<\/jats:title>\n            <jats:p>To determine if the use of autogenous bone graft is necessary for the treatment of humeral shaft nonunions after initial nonoperative management.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Retrospective.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>Level 1 academic trauma center.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patient Selection Criteria:<\/jats:title>\n            <jats:p>All skeletally mature patients undergoing nonunion repair of a humeral shaft fracture (OTA\/AO 12A, 12B, 12C) after initial nonoperative management of the acute fracture.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Outcome Measures and Comparisons:<\/jats:title>\n            <jats:p>The primary outcome was osseous union. Failure of nonunion repair was defined by lack of osseous union within 365 days from surgery and\/or return to the operating room for additional attempts to promote union. Secondary outcomes included complications including infection, radial nerve palsy, and donor site morbidity.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>Seventy-two patients were included in the final cohort. Thirty-eight patients (53%) were female, and the average age was 51 (SD 18, range 17, 83). Two patients (3%) developed a recalcitrant nonunion, both of which healed after a second procedure consisting of revision compression plating. The use of bone autograft was uncommon overall in this cohort (4 patients, 6%). Bone morphogenic protein, bone allograft, or demineralized bone matrix was used in 12 patients (17%). The remaining 56 patients (78%) were treated with compression plating alone. Compression was generated through multiple techniques including use of the articulated tensioning device, a pull screw with a verbrugge clamp, lag screw application, and compression generated via eccentric drilling through the plate. There were no differences in terms of patient demographics, fracture, or injury characteristics between the groups that received autograft and those who did not (<jats:italic toggle=\"yes\">P<\/jats:italic> &gt; 0.05). Use of autograft or other biologic supplementation was not associated with a statistically significant increase in union rate, 100% versus 97% (<jats:italic toggle=\"yes\">P<\/jats:italic> = 1.00). In the 4 patients who underwent autogenous bone grafting, there were no reported donor site complications.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>For humeral shaft fractures initially treated nonoperatively that went on to nonunion or anticipated nonunion, the union rate for compression plating alone was comparable with the union rate noted in the literature after treatment with bone autograft and compression plating. These results suggest that routine use of bone autograft may be unnecessary in the treatment of humeral shaft nonunions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>LEVEL OF EVIDENCE:<\/jats:title>\n            <jats:p>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000003028","type":"journal-article","created":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T13:00:14Z","timestamp":1749733214000},"page":"542-548","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Routine Use of Autograft Is Not Necessary for Treatment of Humeral Shaft Nonunions and Anticipated Nonunions After Failed Nonoperative Treatment"],"prefix":"10.1097","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9229-745X","authenticated-orcid":false,"given":"Erika","family":"Roddy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonah Hebert","family":"Davis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Firoozabadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Barei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250921","doi-asserted-by":"crossref","first-page":"50","DOI":"10.5435\/JAAOS-D-21-00634","article-title":"Approach to humeral shaft nonunion: evaluation and surgical techniques","volume":"30","author":"Naclerio","year":"2022","journal-title":"J Am Acad Orthop Surg"},{"key":"R2-20250921","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1097\/BOT.0000000000000960","article-title":"Fracture site mobility at 6 weeks after humeral shaft fracture predicts nonunion without surgery","volume":"31","author":"Driesman","year":"2017","journal-title":"J Orthop Trauma"},{"key":"R3-20250921","doi-asserted-by":"crossref","first-page":"2314","DOI":"10.1016\/j.injury.2015.09.041","article-title":"Union rate after operative treatment of humeral shaft nonunion\u2014a systematic review","volume":"46","author":"Peters","year":"2015","journal-title":"Injury"},{"key":"R4-20250921","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1097\/00005131-200202000-00007","article-title":"Humeral shaft nonunion: evaluation of uniform surgical repair in fifty-one patients","volume":"16","author":"Marti","year":"2002","journal-title":"J Orthop Trauma"},{"issue":"suppl 2","key":"R5-20250921","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1097\/BOT.0000000000002154","article-title":"Repair of humeral shaft nonunion with plate and screw fixation and iliac crest bone graft","volume":"35","author":"Stevens","year":"2021","journal-title":"J Orthop Trauma"},{"key":"R6-20250921","doi-asserted-by":"crossref","first-page":"375","DOI":"10.2106\/JBJS.19.01115","article-title":"Healing the index humeral shaft nonunion: risk factors for development of a recalcitrant nonunion in 125 patients","volume":"102","author":"Wiss","year":"2020","journal-title":"J Bone Joint Surg Am"},{"key":"R7-20250921","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1302\/0301-620X.98B7.36061","article-title":"A unified theory of bone healing and nonunion: BHN theory","volume":"98-B","author":"Elliott","year":"2016","journal-title":"Bone Joint J"},{"issue":"suppl 6","key":"R8-20250921","doi-asserted-by":"crossref","first-page":"S116","DOI":"10.1016\/j.injury.2014.10.034","article-title":"Incidence of donor site morbidity following harvesting from iliac crest or RIA graft","volume":"45","author":"Calori","year":"2014","journal-title":"Injury"},{"key":"R9-20250921","first-page":"510","article-title":"Persistent iliac crest donor site pain: independent outcome assessment","volume":"50","author":"Heary","year":"2002","journal-title":"Neurosurgery"},{"key":"R10-20250921","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1097\/00007632-200301150-00008","article-title":"Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion","volume":"28","author":"Silber","year":"2003","journal-title":"Spine (Phila Pa 1976)"},{"key":"R11-20250921","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1097\/00003086-197510000-00033","article-title":"Fractures of the humeral shaft: a retrospective study of 240 adult fractures","volume":"112","author":"Mast","year":"1975","journal-title":"Clin Orthop Relat Res"},{"key":"R12-20250921","doi-asserted-by":"crossref","first-page":"403","DOI":"10.2106\/JBJS.M.00089","article-title":"Risk factors for fracture mobility six weeks after initiation of brace treatment of mid-diaphyseal humeral fractures","volume":"96","author":"Neuhaus","year":"2014","journal-title":"J Bone Joint Surg Am"},{"key":"R13-20250921","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1097\/BOT.0000000000002032","article-title":"Open reduction and internal fixation for humeral shaft nonunion: bone grafting is not routinely required and avoids donor site morbidity","volume":"35","author":"Oliver","year":"2021","journal-title":"J Orthop Trauma"},{"key":"R14-20250921","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.jse.2014.05.009","article-title":"Nonoperative treatment of humeral shaft fractures revisited","volume":"24","author":"Ali","year":"2015","journal-title":"J Shoulder Elbow Surg"},{"key":"R15-20250921","doi-asserted-by":"crossref","first-page":"1792","DOI":"10.1001\/jama.2020.3182","article-title":"Effect of surgery vs functional bracing on functional outcome among patients with closed displaced humeral shaft fractures: the FISH randomized clinical trial","volume":"323","author":"R\u00e4m\u00f6","year":"2020","journal-title":"JAMA"},{"key":"R16-20250921","doi-asserted-by":"crossref","first-page":"e227","DOI":"10.1097\/BOT.0000000000002315","article-title":"Factors associated with patient-reported outcomes following a humeral shaft fracture: nonunion results in a poorer outcome despite union after surgical fixation","volume":"36","author":"Oliver","year":"2022","journal-title":"J Orthop Trauma"},{"issue":"suppl 1","key":"R17-20250921","doi-asserted-by":"crossref","first-page":"S6","DOI":"10.1097\/BOT.0000000000001206","article-title":"Surgical technique: anterolateral approach to the humerus","volume":"32","author":"Liskutin","year":"2018","journal-title":"J Orthop Trauma"},{"key":"R18-20250921","doi-asserted-by":"crossref","first-page":"1690","DOI":"10.2106\/00004623-199611000-00008","article-title":"Alternative operative exposures of the posterior aspect of the humeral diaphysis with reference to the radial nerve","volume":"78","author":"Gerwin","year":"1996","journal-title":"J Bone Joint Surg Am"},{"key":"R19-20250921","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1097\/BOT.0b013e318177eb23","article-title":"Shortening osteotomy and compression plating for atrophic humeral nonunions: surgical technique","volume":"22","author":"Brennan","year":"2008","journal-title":"J Orthop Trauma"},{"key":"R20-20250921","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/S0020-1383(00)00231-X","article-title":"Plate osteosynthesis for pseudarthrosis of the humeral shaft","volume":"32","author":"te Velde","year":"2001","journal-title":"Injury"},{"key":"R21-20250921","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1007\/s00264-009-0863-5","article-title":"Anterior plating as a surgical alternative in the treatment of humeral shaft non-union","volume":"34","author":"Livani","year":"2010","journal-title":"Int Orthop"},{"key":"R22-20250921","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s11420-015-9453-9","article-title":"Initial surgical treatment of humeral shaft fracture predicts difficulty healing when humeral shaft nonunion occurs","volume":"12","author":"Konda","year":"2016","journal-title":"HSS J"},{"key":"R23-20250921","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.1016\/j.injury.2011.03.045","article-title":"Judet decortication and compression plate fixation of long bone non-union: is bone graft necessary?","volume":"42","author":"Ramoutar","year":"2011","journal-title":"Injury"},{"key":"R24-20250921","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.2106\/00004623-200211000-00001","article-title":"Expression and activation of the BMP-signaling components in human fracture nonunions","volume":"84","author":"Kloen","year":"2002","journal-title":"J Bone Joint Surg Am"},{"key":"R25-20250921","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1111\/jcmm.17096","article-title":"Biological and molecular profile of fracture non-union tissue: a systematic review and an update on current insights","volume":"26","author":"Panteli","year":"2022","journal-title":"J Cell Mol Med"}],"container-title":["Journal of Orthopaedic Trauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/BOT.0000000000003028","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T15:00:45Z","timestamp":1758466845000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/BOT.0000000000003028"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":25,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1097\/bot.0000000000003028","relation":{},"ISSN":["0890-5339","1531-2291"],"issn-type":[{"value":"0890-5339","type":"print"},{"value":"1531-2291","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"2025-06-05","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}