We present a case of humeral nonunion managed with a dynamic compression plate (DCP) contoured in a spiral fashion to preserve the deltoid muscle insertion. A forty-one-year-old woman sustained a closed proximal third humeral shaft fracture with an associated supraclavicular brachial plexus injury. She presented five months later with an atrophic nonunion of the proximal humeral shaft, inferior subluxation of the humeral head, and a resolving brachial plexopathy. Autogenous cancellous bone grafting and open reduction and internal fixation with a narrow DCP was performed. The deltoid muscle insertion was preserved by contouring the plate to fix the proximal humerus laterally over the greater tuberosity and anteriorly over the mid-humeral shaft. During the postoperative period, the humeral head reduced spontaneously. Five months after surgery, the fracture healed, and an excellent clinical result was achieved. We recommend the use of the spiral DCP for proximal shaft fractures and nonunions when preservation of the deltoid insertion is desirable.
Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
Accepted November 17, 1998.
Address correspondence and reprint requests to Dr. Michael E. Torchia, Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, U.S.A.
No financial support of this research project has occurred. The authors have received nothing of value.
The devices that are the subject of this manuscript are FDA-approved.
