Fig. 2

A 95-year-old female fell and sustained a midshaft humerus fracture which was treated with a Sarmiento brace at a local hospital. She was referred at five months for a second opinion and presented with pain, a flail arm and radiographic imaging demonstrating lack of fracture callus (A, B). Open reduction and internal fixation was performed with debridement of the nonunion site, removal of bone edges along the nonunion site, and intrameduallary placement of fibular allograft (C). This was followed by compression of the construct around the allograft with placement of an anterior 3.5 mm locking compression pelvic reconstruction plate anterolaterally and a long Philos plate laterally including screws through all 4 cortices through the allograft (D, E). During fluoroscopy at the end of surgical procedure the arm was externally rotated for a final image, which unfortunately led to an iatrogenic fracture of the metaphyseal distal humerus which was then fixated with a second contoured 3.5 mm pelvic recon locking compression pelvic reconstruction plate (F). She returned for routine follow-up and at 4 months radiographic and clinical findings demonstrated a healed humeral nonunion and fracture (G, H); and at most recent contact she is doing well, 99 years of age and has a pain-free arm