MANAGEMENT OF HUMERAL NONUNION AFTER THE FAILURE OF LOCKING INTRAMEDULLARY NAILS

We reviewed 21 cases of humeral nonunion following the failure of ''lo cking'' humeral nails. The nails had been inserted as the primary oper ative procedure following humeral fracture in fifteen cases or after t he failure of closed treatment in six cases. Reconstruction after the failure of these implants was complicated by poor bone stock and diffi culty in achieving union. Although technically difficult, open reducti on and internal fixation with plating and bone grafting (successful in nine of nine cases) was more consistent than exchange nailing (succes sful in four of 10 cases) in achieving union (p = 0.01). Two patients refused further surgical intervention. The degree of bone loss associa ted with a loose nail, the lack of success of exchange nailing, and th e insertion site morbidity associated with humeral nail removal differ entiate these nonunions from similar lower extremity problems. The deg ree of bone loss following failed locking nailing of the humerus is a major concern, and exchange nailing alone may not bean acceptable opti on to deal with this problem.