Nonunion (unhealed fracture) with deformity treatment

A 46-year-old female fell while walking and landed on her left outstretched upper extremity.

Radiographs taken at a local hospital revealed a left-sided displaced mid-shaft humerus fracture with a fracture line extending to the distal humerus. She was initially treated by the outside hospital with a Sarmiento fracture brace for 6 months.

She was referred to us at 6 months for treatment of an unhealed fracture of the humerus. Radiographs at that time revealed a humeral non-union with significant angular (varus/recurvatum) and rotational deformities with evidence of fracture callus formation at the distal humerus fracture line.

Open Reduction and Interanal Fixation (ORIF) was performed with debridement of the non-union, placement of bone graft, and placement of locking and reconstruction plates and screws in a 90/90 fashion including an interfragmentary lag screw.

She returned for regular follow-up visits and healed uneventfully. At her latest follow-up visit 13 months following surgery she had excellent radiographic and clinical results including a healed humeral nonunion, resolution of pain and full range of motion of the shoulder and elbow joints and she returned to all pre-injury activities.

  • Figure A

    Figure A

    Anteroposterior (AP) injury radiograph revealing a mid-shaft humerus fracture with a fracture line extending to the distal humurus.

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  • Figure B

    Figure B

    Radiographs at 6 months following the injury illustrating a humeral non-union with significant deformity.

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  • Figure C

    Figure C

    AP and lateral radiographs 7 weeks following surgery revealing early callus formation and adequate hardware positioning.

    Enlarge

  • Figure D

    Figure D

    AP and lateral radiographs at 13 months illustrating a healed humerus fracture in excellent alignment.

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David L. Helfet, MD

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New York Fracture Care

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