Year: 2026 | Month: October | Volume: 13 | Issue: 10 | Pages: 484-490
DOI: https://doi.org/10.52403/ijrr.20261044
Successful Union After Revision Plating for Non-Union of Humeral Shaft Fracture Initially Treated with Intramedullary Nailing: A Clinical Case Report
Adhi Satriyo Utomo1,2, Wintang Dayinta Tanaya Hutami1
1Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Brawijaya – Dr. Saiful Anwar General Hospital, Malang, Indonesia
2Brawijaya University Hospital, Universitas Brawijaya
Corresponding Author: Adhi Satriyo Utomo
ABSTRACT
Introduction: The optimal fixation method for humeral shaft fractures remains debated, particularly between intramedullary nailing and plate fixation. Although intramedullary nailing is minimally invasive, its mechanical stability may be insufficient for simple transverse fractures requiring interfragmentary compression, potentially increasing the risk of non-union.
Case Presentation: A 15-year-old female sustained a proximal humeral shaft fracture following a low-energy fall and underwent antegrade intramedullary nailing. Persistent pain and restricted shoulder motion were noted during follow-up. At six months, radiographs demonstrated a persistent fracture gap with sclerotic margins and no bridging callus, consistent with atrophic non-union. Revision surgery included nail removal, debridement of the fibrous interface, and compression plate fixation. Complete cortical union and full functional recovery were achieved within twelve weeks.
Clinical Discussion: This case demonstrates the mechanical limitations of intramedullary nailing in simple transverse humeral shaft fractures. Limited interfragmentary compression and persistent micromotion may impair fracture healing. Compression plating provides greater control of fracture reduction, enables direct compression, and facilitates debridement of the non-union site.
Conclusion: Implant selection for adolescent humeral shaft fractures should consider fracture biomechanics rather than surgical invasiveness alone. In transverse fractures requiring absolute stability, inadequate fixation with intramedullary nailing may contribute to non-union. Early recognition and conversion to compression plate fixation can restore mechanical stability, promote union, and achieve satisfactory functional recovery.
Keywords: bone plate, humeral fracture, intramedullary nailing, non-union fracture.
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