Rare "double tragedy" and successful salvage strategy after failed bilateral humeral fracture fixation in a...

Bilateral humeral shaft fractures are rare injuries that present significant management challenges, particularly in resource-constrained settings. This case report highlights the complexities of treating bilateral humeral shaft fractures in a 40-year-old male patient from southwestern Nigeria, whose treatment was initially complicated by failed plate osteosyntheses. The objectives of this report are (1) to illustrate the unusual injury patterns that result from inadequate transportation infrastructure in developing countries, (2) to highlight the challenges patients and surgeons face in managing fractures in resource-constrained environments, and (3) to emphasize the critical role humanitarian organizations play in enhancing orthopedic care and achieving positive patient outcomes in these settings.

A 40-year-old male patient, the primary earner for his family, presented to our facility three months after a road traffic crash with bilateral upper limb dysfunction. While driving with his seatbelt fastened, a trailer truck struck his car on the driver's side, resulting in bilateral closed humeral shaft fractures, a mild traumatic brain injury, and minor skin abrasions. Initial plate osteosynthesis at a private peripheral hospital failed, resulting in bilateral nonunions. Upon presentation at our facility, the patient had normal vital signs and preserved neurovascular function, but limited upper-limb mobility. He underwent staged treatment, which involved removal of the plates, Surgical Implant Generation Network (SIGN) nail (Richland, WA, USA) fixation, and cancellous autografting. Despite financial constraints and infection complications, both fractures achieved union and functional recovery after two years.

This case underscores the challenges of managing complex orthopaedic trauma in low-resource settings, where inadequate healthcare infrastructure, limited access to suitable implants, and insufficient health insurance coverage exacerbate treatment difficulties. The successful outcome in this case was achieved through staged treatment, collaboration with the patient, and the use of donated SIGN nails. The report emphasizes the necessity for innovative solutions, collaborative efforts, and policy reforms to enhance fracture management outcomes and prevent long-term disabilities in resource-constrained settings. The role of humanitarian organizations in bridging the gap in orthopaedic care is also highlighted, demonstrating the potential for positive outcomes despite significant challenges.