In 2003, Jim came to our clinic with a left proximal humerus nonunion after a previous attempt at open reduction percutaneous pinning and an attempt at open reduction internal fixation with plate and screws. He was experiencing a decreasing ability to abduct his arm and his shoulder was grinding and clicking.
He had significantly diminished range of motion and was only able to abduct his arm 45°. His radiographs showed a mild excavation of the humeral head and loosening of the blade plate and screws. He was elected for repeat operation, which involved takedown of the proximal humerus nonunion and repeat internal fixation with a "peg bone graft" to make an intramedullary bony bridge between the humeral shaft and the head.
At his 1 year follow up visit Jim was doing great. He had no instability at the fracture site and he was back to doing overhead activities without pain. He could even sleep on his shoulder without difficulty. However, about 6 months later, Jim fell and re-fractured his shoulder. He was taken back to the operating room and had a repeat open reduction internal fixation with a proximal humeral plate and vascularized scapular bone transfer.
Six month later Jim was feeling significantly improved. His was able to elevate his arm 140°. He said his shoulder was as “good as it’s ever been” since his original fracture.
Jim visited our clinic 8 and a half years later to show that he is still doing exceedingly well. He rated his shoulder at 97.5% of normal.