Salvage of humeral shaft nonunion with cortical thinning after failed intramedullary nailing using Ilizarov's technique A report of seven cases

Open reduction and plate fixation with bone grafting is regarded as the best treatment of humeral shaft nonunion after nonoperative treatment. However, nonunion that occurs after locking intramedullary (IM) nailing offers a different challenge. Unlike the situation in the tibia and femur, exchange nailing works poorly. Long-lasting nonunion with a loose nail because of a windshield wiper-like effect of the nail can lead to cortical thinning (Fig. 1), a condition that is rarely seen in the femur or tibia and it is different from osteoporosis due to disuse or old age. Severely compromised bone usually makes internal fixation difficult, and plate loosening often occurs. Hence, special techniques may be needed to treat these difficult cases. We present our experience of using Ilizarov’s technique to treat humeral shaft nonunion with cortical thinning following IM nailing.