Treatment of 10 year humeral shaft nonunion with segment bony defect: a case report

Humeral shaft nonunions with severe osteopenia presents challenges. Because of previous surgeries, complex anatomy of vascular, muscles and nerves at the nonunion site making the operation difficulty and risky. Vascularized fibula transfer and bone transporting are particularly useful in handling bone loss. However both methods require surgical experience and facility which are not available in many hospital. Furthermore, the method also needs time and resources. To our knowledge, no cases of 10 year humeral shaft nonunion with 7.5 cm segment bony defect treated by compression plating and autologous iliac bone grafts have been described. We report a 67-year-old man suffer duration of nonunion approximately 123 months since his initial injury, the nonunion site defects reach as large as 7.5 cm. He underwent osteosynthesis using a dynamic compression plate augmented with autologous iliac crest bone graft and cancellous bone. At the 27-months follow-up, bone union finally, the patient was free of pain and had no evidence of shoulder and elbow movements restrictions. Our method using dynamic compression plate augmented with autologous iliac crest bone graft and cancellous bone may provide an effective alternative in treating atrophic humeral shaft nonunion complicated by massive bone loss.