Excellent clinical and radiological outcome of disabled upper extremity after humerus hypertrophic nonunion with implant failure in geriatric patient treated with compression plate: A case report.

Introduction: Nonunion treatment decisions are influenced by the classification of nonunion patterns identified. Surgical intervention, frequently incorporating compression devices, is a prevalent strategy utilized in the management of nonunion fractures. This report aimed to explain the result of treatment of hypertrophic nonunion with compression plate. Case presentation: A 65-year-old female patient presented with chronic pain and limited range of motion in her left arm subsequent to an inadequately healed humerus fracture. A proximal humerus compression plate with autologous bone graft was utilized in conjunction with osteoperiosteal decortication and fibrotic tissue release to achieve an immediate postoperative improvement and enhanced functional outcomes. Discussion: Nonunion of fractures presents a significant challenge that requires a tailored approach based on injury mechanism, patient health, and prior interventions. Factors such as soft-tissue condition, bone quality, and infection must be assessed to determine the optimal surgical strategy. In this case, the initial fixation was inadequate, leading to hypertrophic nonunion. Compression plating fixation generally provides better outcomes for nonunion treatment compared to intramedullary nailing, particularly for unstable or failed initial fixations. Revision surgery involved implant removal, nerve release, osteoperiosteal decortication, and the use of a proximal humerus compression plate with an autologous bone graft, resulting in improved stability and healing. Conclusion: This case highlights the challenges and treatment considerations in managing hypertrophic nonunion humerus fractures. Tailored surgical strategies informed by patient-specific factors play a crucial role in optimizing the outcomes.