Dual Plating with 4.5mm PHILOS for Managing Challenging Humerus Shaft Non-Unions: A Novel Technique.

Introduction: Fixation failures of humeral shaft fractures are uncommon. When they do occur, revision fixation can be challenging. This study aims to evaluate the clinical and radiological outcomes of a novel surgical technique for managing challenging humerus midshaft fractures and non-unions, specifically assessing union and complication rates. Materials and methods: This retrospective study included all consecutive patients who underwent surgical fixation of midshaft humerus fractures using our novel dual plating technique between October 2016 and July 2019. Six patients were included. At follow-up, union was assessed using plain films. Results: Mean age was 50.8 ± 18.0 years, including 4 males and 2 females. All surgeries were revision fixations except for one primary fixation. Mean follow-up period was 6.5 ± 2.3 months. At final follow-up, 5 of 6 patients (83.3%) achieved clinical and radiographic union, with a mean time to union of 6.4 ± 2.0 months. Residual angular deformity at union averaged 1.2 ± 0.8° in the coronal plane and 2.0 ± 2.0° in the sagittal plane. Aside from one case of delayed union, no major complications were reported. Conclusion: The novel dual plating technique can be reliably executed with good results and shows promise as a surgical treatment option for non-union or implant failure. While particularly valuable in revision settings, it may be considered for challenging primary fixations. Further research is needed before recommending its widespread use in primary fracture management.