Figure 5.

Proximal humeral nonunion and broken/failing hardware. Radiographs of an 80-year-old woman with ongoing pain and dysfunction of her left arm following multiple previous surgeries over the past year, demonstrating a proximal humeral nonunion and broken/failing hardware (A). She had no clinical signs of infection. Her infectious bloodwork demonstrated mildly elevated WBC, ESR, and CRP. She underwent revision surgery consisting of complete hardware removal, irrigation, and debridement with deep cultures and revision open reduction internal fixation of her left humerus. The broken screws were removed with a hollow reverse cutting reamer and conical extractor (D). A tibial strut allograft was used to provide additional stability across the nonunion and a proximal humerus locking plate was applied (E). In addition, cancellous morselized allograft and bone morphogenetic protein (BMP, Infuse, Medtronic) were applied at the nonunion/bone defect site. All of her intraoperative cultures were negative at 14 days. Follow-up x-rays at 1 year demonstrate bony union and the final construct (B and C).