Twenty-year Delayed Failure of an Intramedullary Humeral Nail Due to Shaft Non-union and its Surgical Management: A Case Report.

INTRODUCTION

Non-union following humeral shaft fractures is an uncommon yet disabling complication that may ultimately lead to implant failure in the presence of persistent mechanical instability. Delayed, non-traumatic breakage of an intramedullary nail several decades after fixation is exceedingly rare.

CASE REPORT: We report the case of a 44-year-old male who presented 20 years after primary intramedullary interlocking nailing for a humeral shaft fracture with progressive arm pain, functional limitation, established mid-diaphyseal non-union, and spontaneous nail breakage in the absence of new trauma. The patient was managed with a single-stage surgical procedure comprising implant removal, thorough debridement of the non-union site, open reduction and internal fixation using compression plating, and augmentation with autogenous iliac crest bone graft. The post-operative course was uneventful, and serial radiographs demonstrated progressive healing with solid union and restoration of function.

CONCLUSION

This case highlights the importance of addressing both mechanical stability and the biological environment in the management of chronic humeral shaft non-union and supports single-stage nail removal followed by compression plating with autologous bone grafting as a reliable treatment strategy for rare late implant failures.