Antegrade intramedullary nail and plate combination technique for proximal humeral non-union: A case report

Proximal humeral nonunion remains a challenging condition, particularly after failed plate fixation, because of the compromised bone stock within the humeral head and loss of medial calcar support. Under these conditions, it is often difficult to achieve sufficient mechanical stability while preserving the humeral head. We report a case of proximal humeral nonunion successfully treated using the nail and plate combination technique. A 61-year-old man sustained a high-energy proximal humeral fracture in a motorcycle accident and underwent initial plate fixation at a different institution. The plate failed subsequently, resulting in varus displacement of the humeral head fragment and nonunion. Revision surgery was performed using an antegrade intramedullary nail combined with an anatomical proximal humeral locking plate and cancellous iliac bone grafting. This strategy was selected to restore medial calcar support, enhance axial stability, and increase the number of screws engaging the humeral head fragment without interfering with the implant. Postoperative imaging confirmed satisfactory alignment and stable fixation at the nonunion site. Bone union was achieved without displacement, and solid union was confirmed at the final, 2-year follow-up visit. At the same visit, shoulder function was favorable, with a Constant-Murley score of 82 points and preservation of a wide range of motion. The nail and plate combination technique may represent a useful treatment option for proximal humeral nonunion in selected patients, providing complementary mechanical stability that is difficult to achieve with single-implant fixation alone while preserving the humeral head.