Humeral pseudarthrosis (6)

29-year-old patient with pseudarthrosis of the humeral shaft. The patient had previously sustained a lower-level fracture that also progressed to pseudarthrosis. The patient carried osteosynthesis material in the form of an unanchored plate at the lateral aspect of the humerus, causing radial nerve paralysis thought to be irreversible.

Pseudarthrosis treatment consisted of removing the osteosynthesis material and releasing as far as possible the radial nerve that was encased in the pseudarthrosis fibrous tissue. Focal curettage was conducted and a new osteosynthesis operation was performed, locating the plate on the posterior side of the humerus as this was deemed to offer the greatest degree of stabilisation.

Pseudarthrosis stem cell therapy consisted of the insertion of a bone graft comprising 250 million bone marrow stem cells cultured at the Barcelona Blood and Tissue Bank with the Aastrom Replicell bioreactor, beta tricalcium phosphate granules and autologous plasma clot. The patient's progression was very satisfactory and consolidation was confirmed at 6 months.

A key aspect of this case was the recuperation of radial nerve function despite a prognosis to the contrary, which allowed the patient to resume his favourite hobby. The photograph on the right shows the patient's dorsiflexion of the wrist and finger extension which was previously impossible due the nerve damage.