Treatment of humeral shaft non-union by exchange intramedullary nailing and circumferential cortical strut allograft: the Sarcophagus technique

<h2>Abstract</h2><h3>Background</h3> Non-union of the humeral shaft presents a complex surgical challenge, with ongoing debate surrounding optimal fixation and grafting strategies. This study evaluates the clinical and radiographic outcomes of a novel surgical approach, intramedullary nailing combined with circumferential (360°) cortical strut allografting, termed the Sarcophagus technique. We hypothesized that the Sarcophagus technique would be a safe and effective treatment strategy for humeral shaft non-union, offering union rates comparable to conventional techniques. <h3>Patients and methods</h3> We conducted a retrospective case series of eight patients with aseptic, atrophic humeral shaft non-union treated using the Sarcophagus technique between 2017 and 2021. All patients had previously undergone intramedullary nailing as the index treatment. The primary outcome was radiographic union at 12 months. Secondary outcomes included time to union, complication rates, and functional scores (ASES, Simple Shoulder Test, QuickDASH, Auto-Constant) assessed at 3, 6, and 12 months. <h3>Results</h3> Radiographic union was achieved in 7 of 8 patients (87.5%), with a mean time to union of 5.8 ± 1.3 months. Functional outcomes demonstrated progressive improvement across all measures during follow-up. No postoperative infections occurred. One patient had persistent fracture non-union but remained minimally symptomatic and declined re-revision. Transient radial nerve palsy occurred in one patient (12.5%) and resolved spontaneously within three months. <h3>Conclusion</h3> The Sarcophagus technique demonstrated a high union rate and favorable functional recovery in patients with humeral shaft non-union. Larger comparative studies are warranted to further establish the role of this technique in complex humeral non-unions.