Distal Humeral Shaft Fracture in Osteogenesis Imperfecta Patient Fixed Initially with Elastic Nails, Converted to Slim Nail with a Supplemental Plate due to Non-union

A 17-year-old female with osteogenesis imperfecta type 3 sustained a right distal humerus fracture that was treated initially at our institution with two retrograde titanium elastic nails (TENs). One year later, the fracture site remained a hypertrophic non-union and elastic nails were removed at another institution to address protrusion of the nails through the skin. The patient continued her follow-up back at our institution and developed a painful pseudoarthrosis with malalignment. The hypertrophic malunion was addressed by debridement of the non-union site, open reduction and fixation with retrograde the simple locking intramedullary (SLIM) system nail, autogenous iliac crest bone graft and demineralized bone matrix (DBM) graft, and supplemental locked plating.