Humeral Nonunion

Humeral shaft nonunions occur in up to 10% of humeral fractures treated nonoperatively and in up to 15% of fractures treated surgically. Surgical management should be considered for fractures that have no evidence of progressive healing on consecutive radiographs taken at least 6–8 weeks apart during the course of closed treatment. In the setting of established nonunion of the humeral shaft, the goals of surgical treatment include correction of deformity and achievement of union to relieve pain and restore function of the upper extremity. Open reduction and internal fixation with compression plating and bone graft remain the standard of care, with a >90% rate of union and good functional outcomes. Recent studies support the use of locked compression plates, dual plating, and cortical allograft struts in patients with osteopenic bone.