Humeral Shaft Nonunion Following Inadvertent Reaming During Intramedullary Nailing: A Case Report

Fallah, Yousef; Mahdavi, Farhad

doi:10.30491/tm.2026.592446.1965

Humeral Shaft Nonunion Following Inadvertent Reaming During Intramedullary Nailing: A Case Report

Document Type : Case Report

Authors

Yousef Fallah

Farhad Mahdavi

Department of Orthopedic Surgery, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

10.30491/tm.2026.592446.1965

Abstract

Introduction: Intramedullary nailing is an established treatment for humeral shaft fractures and is commonly performed using an unreamed technique. Inadvertent reaming during a procedure intended to be unreamed may affect the local biological environment, although its clinical significance remains uncertain. We present a case of humeral shaft nonunion and subsequent mechanical complications following inadvertent reaming during antegrade intramedullary nailing.
Case presentation: A 39-year-old man sustained a closed, approximately mid-shaft, non-comminuted humeral fracture following a motor vehicle accident. The patient was a non-smoker with a BMI of 28 kg/m² and no significant metabolic or systemic comorbidities. The planned procedure was antegrade intramedullary fixation with a 9-mm nail and two proximal and two distal locking screws, without reaming. However, inadvertent reaming of the humeral canal was performed; the reamer diameter was not documented. Fracture reduction was satisfactory, and no intraoperative soft-tissue interposition was identified. Postoperatively, the patient developed radial nerve dysfunction, with EMG/NCS approximately one month later reportedly demonstrating injury at the mid-shaft/arm level. Radial nerve function recovered completely within approximately three months. At approximately six months, persistent nonunion was associated with a distal periprosthetic fracture at the nail tip. During revision surgery, the nail was loose, and the bone surrounding the nonunion was markedly soft and poorly bleeding. Approximately 4 cm of abnormal-appearing bone was resected until viable bleeding bone was encountered. The nail was removed, followed by compression plate fixation and autologous iliac crest bone grafting. Complete union was subsequently achieved.
Conclusion: This case highlights potential clinical consequences following inadvertent reaming during intended unreamed humeral nailing. Although the intraoperative findings raised suspicion of compromised bone viability, the absence of histopathological confirmation and undocumented reaming parameters preclude establishing a direct causal relationship between reaming, thermal injury, and nonunion. Strict adherence to the planned surgical technique and close postoperative surveillance are warranted.

Keywords

Humeral shaft nonunion

Intramedullary nailing

Reaming

Thermal osteonecrosis

Periprosthetic fracture. inadvertent reaming

Subjects