SURGICAL MANAGEMENT OF HUMERAL SHAFT FRACTURE NONUNION. A TERTIARY REFERRAL CENTRE EXPERIENCE IN 122 CASES: LESSONS LEARNED

Humeral shaft fracture nonunion remains a complex orthopaedic challenge associated with persistent pain, functional impairment, and reduced quality of life. Revision surgery is frequently required following failed primary fixation, with the primary objectives of achieving osseous union, restoring alignment, and improving upper limb function. This study aimed to evaluate the radiological and patient-reported outcomes of revision surgery for humeral shaft fracture nonunion in a large cohort managed at a tertiary referral centre. A retrospective case series was conducted involving 122 patients who underwent revision surgery for humeral shaft fracture nonunion at a tertiary orthopaedic referral unit between 2009 and 2026. Demographic characteristics, mechanism of injury, initial treatment modality, duration of nonunion, smoking status, comorbidities, and previous surgical interventions were reviewed. Revision procedures included thorough debridement of the nonunion site, microbiological and histopathological tissue sampling, and either single-stage or two-stage revision fixation. Patients were followed clinically and radiographically until fracture union or final follow-up. Primary outcome measures included union rate and time to union. Secondary outcomes included complications, reoperation rate, and functional recovery. A total of 122 patients with humeral shaft fracture nonunion underwent revision surgery. The mean patient age was 55 years, with a mean follow-up duration of 25.3 months. Radiological union was achieved in 114 of 122 cases (94%) at a mean time to union of 11 months. Autologous bone grafting was performed in 95 patients (77%). The most commonly isolated microorganisms were Propionibacterium acnes, Staphylococcus capitis, Staphylococcus epidermidis , and Pseudomonas species. Complications included infection, implant failure, transient radial nerve palsy, and persistent nonunion in a minority of cases. Functional outcomes demonstrated substantial improvement in pain and upper extremity function following revision surgery. Revision surgery for humeral shaft fracture nonunion achieves high rates of fracture union and satisfactory functional outcomes when combined with meticulous debridement, stable fixation, and appropriate biological augmentation. Adherence to the principles of “C.CABSI” — Contact, Compression, Alignment, Biomechanical Stabilisation, Stimulation, and Infection management — was associated with a high rate of successful outcomes. This large case series supports revision fixation with adjunctive bone grafting as an effective strategy in the management of humeral shaft fracture nonunion.