Humeral Head Nonunion

  • Stefano Di Fabio
  • Corrado D’Antimo


Fractures of the proximal humerus are common, and the majority of them unite successfully, many without surgical operation. A small percentage develop into nonunion. Nonunion of the proximal humerus presents different challenges due to biological insults from the initial injury and previous surgeries, bone loss, humeral head cavitation, osteopenia, soft tissue contractures, and infection.

Risk factors for developing a nonunion include facture characteristics, such as increased fracture translation and bonny comminutions, but the relationship of these parameters is not simple. Patients-related risk factors include nutritional or metabolic deficiencies, smoking, and medical comorbidities.

Once a nonunion has been identified, every effort should be made to address the problem before 6 months after the initial injury and prior to developing glenohumeral soft tissue contractures which may further limit the patient’s function and increase pain level creating a vicious circle potentially very dangerous.

Treatment options in case of nonunion are wide and range from nonsurgical management for minimally symptomatic patients to surgical option including osteosynthesis with last generation locking plates, interlocked intramedullary implant, and arthroplasty ranging from hemiarthroplasty to total or reverse shoulder prosthesis. Reconstruction surgery may include augments such as autograft, allograft, or structural grafts. The surgical goals are to provide a stable mechanical construct that allows early mobilization and to create a biological environment favorable to fracture healing.


Proximal humerus Fracture Nonunion Plate fixation Bone graft Shoulder arthroplasty 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Stefano Di Fabio
    • 1
  • Corrado D’Antimo
    • 1
  1. 1.Orthopaedics DepartmentSan Martino HospitalBellunoItaly

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