Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the affected arm draped free to allow for manipulation during the procedure.

Anatomical surgical approach:  An extended deltopectoral incision was made, providing access to the humeral shaft. The deltoid muscle was retracted laterally, and the pectoralis major medially, to expose the fracture site. Careful dissection was performed to identify and protect the radial nerve throughout the procedure. Fibrous tissue was excised from the nonunion site, and the fracture ends were refreshed to bleeding bone.

The surgeon noted significant fibrous tissue at the nonunion site, which was meticulously removed. The fracture ends were adequately prepared to receive the bone graft. A long broad LCDCP was applied to achieve compression across the fracture site. Autologous bone graft harvested from the iliac crest was packed around the fracture to enhance healing potential.

Postoperative protocol:   Postoperatively, the patient was advised to maintain immobilization in a sling for comfort for the initial 2 weeks. Gradual passive range of motion exercises were initiated at 2 weeks, progressing to active-assisted exercises by 6 weeks. Full weight-bearing activities were restricted until radiographic evidence of union was observed.

Follow up:   Not specified.

Orthopaedic implants used:   Long broad LCDCP plate, autologous iliac crest bone graft.