Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the affected arm placed on a radiolucent arm board to allow for optimal access and imaging.

Anatomical surgical approach:  A modified Gerwin approach was utilized, involving a posterior incision along the lateral border of the triceps brachii muscle. The radial nerve was carefully identified and neurolysed. The humeral shaft was exposed subperiosteally for grafting and plating.

Intraoperatively, a painful radial nerve neurolysis was performed due to significant scar tissue. A fibula strut graft was placed within the defect for structural support, supplemented by iliac crest bone grafts with osteogenic properties. Double plating was employed to ensure robust fixation and stability of the nonunion site.

Postoperative protocol:   Postoperative rehabilitation included immobilization in a functional brace, with gradual range of motion exercises initiated at 2 weeks post-surgery. Weight-bearing activities were restricted until radiographic evidence of union was observed.

Follow up:   Not specified

Orthopaedic implants used:   Fibula strut graft, iliac crest bone graft, double plating system.