A Case Report of Humeral Nail Breakage after 11 Years Secondary to Shaft Nonunion: Treatment with Autogenous Iliac Crest Bone Graft and Compression Plate.

Abstract

The rate of nonunion of operatively treated fractures of humeral shaft is low. Increased incidence of nonunion is associated with different conditions such as open fractures, bone loss, or fracture gapping. Nonunions after prior intramedullary nailing can be difficult to address, even more with hardware failure. We present the case of a humeral nail breakage 11 years after implantation, secondary to nonunion. A 33-year-old man referred to our hospital with oligotrophic nonunion of the middle humeral diaphysis and nail breakage after 11 years from the first fracture. We decided then to schedule a one-stage surgical procedure of nail removal and new osteosynthesis with autogenous iliac crest bone graft. The patient presented good clinical evolution, without functional limitation or pain. Bone graft union was radiologically confirmed at final follow-up. To the best of our knowledge, this is the first case of non-traumatic nail breakage in a humeral shaft nonunion after such a long period of time. In this case, we found that a one-stage surgical procedure with nail removal and locking compression plate fixation associated with tricortical autogenous iliac crest bone grafting after long-standing humeral shaft nonunion is favorable.