Non-Union Humeral Shaft Fracture with Hardware Failure

  • Molly Hovendick
  • Dylan Morris
  • Matthew O'Brien


Introduction: Humeral shaft fractures account for 3-5% of all fractures.  The unique aspect of this case is the patient suffered from a nonunion humeral fracture but subsequently suffered from surgical hardware failure. Background: The patient is a right hand dominant 66 y.o. male who presented to the emergency department with left arm pain and disability due to a fall from standing height. Initially, he was treated conservatively and placed into a functional brace. At the follow up visit approximately one month later, he reported continued pain and discomfort in his upper extremity. Although there was concern of a possible delayed union due to a history of cigarette smoking and possible noncompliance with post-operative restrictions the patient elected to proceed with open reduction internal fixation (ORIF) the following day. Shortly following surgery, the patient reported a fall reinjuring his left shoulder while mowing his lawn. Previous symptoms were aggravated and signs of hardware failure through the locking plate was suspected. The decision to perform revision ORIF of the fracture using interfragmentary compression plating with lag screw fixation and bone grafting was made and performed approximately seven months following the initial surgery. Discussion: This case report highlights that while the majority of humeral shaft fractures can successfully be treated conservatively, this method may fail and require delayed open reduction internal fixation. Smoking, among other risk factors has been shown to increase the risk of postoperative complications such as non-union, delayed union, infections, and wound healing problems. In this particular case, the patient also suffered from recurrent falls which can add stress to the surgical construct while healing. Conclusion: This case report supports the notion that treating a humeral shaft fracture conservatively with functional bracing does not always lead to successful fracture union given variable comorbidities. Further research needs to detect the influence of associated environmental factors which could have affected fracture healing.