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 David L. Helfet, MD at the Orthopedic Trauma Service of Hospital for Special Surgery 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 internal 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.
Anteroposterior injury radiograph (left image) revealing a mid-shaft humerus fracture with a fracture line extending to the distal humerus and radiographs at 6 months following the injury (right images) illustrating a humeral nonunion with significant deformity.
Anteroposterior and lateral radiographs 7 weeks following surgery (left images) revealing early callus formation and adequate hardware positioning and anteroposterior and lateral radiographs at 13 months (right images) illustrating a healed humerus fracture in excellent alignment.
The HSS Orthopedic Trauma Service has conducted many studies. Please see our publications on humerus fractures, nonunions and use of locking plates in fracture treatment.