Helical plating for a re-nonunion and a peri-implant fracture after humeral intramedullary nailing: A report of two cases.

INTRODUCTION AND

IMPORTANCE

A re-nonunion after failed intramedullary nailing for a nonunion of the humeral shaft and a peri-implant distal humeral fracture with an ununited humeral shaft are rare cases. Therefore, no consensus has been established regarding the treatment strategies.

CASE PRESENTATION: Case 1: An 84-year-old woman presented with humeral shaft re-nonunion after intramedullary nailing. The images revealed callus formation and loosening of the implant, suggesting a lack of mechanical stability. Nail removal and helical plating were performed. One year postoperatively, bony union was achieved. Case 2: A 59-year-old woman presented with a peri-implant distal humeral fracture with an ununited humeral shaft after nailing. Nail removal and helical plating were performed using a minimally invasive plate osteosynthesis (MIPO) technique. The distal humeral fracture was fixed with plates. One year postoperatively, bony union was achieved.

CLINICAL DISCUSSION: Imaging findings in Case 1 indicated that nonunion was caused by a lack of mechanical stability. In Case 2, stabilization of the ununited humeral shaft was also needed. Helical plating provides a mechanically strong fixation and prevents damage to the radial nerve and soft tissues.

CONCLUSION

Evaluating the causative factors of nonunions is important. Helical plating provides mechanical stability and is associated with bony union without autologous bone grafting for a re-nonunion of humeral shaft lacking mechanical instability. For a peri-implant distal humeral fracture with an ununited humeral shaft, helical plating with the MIPO technique provides diaphyseal fracture union and enables the minimal length of distal humeral plate fixation.