OPERATION IN DETAIL: The patient was brought to the operating room and laid supine on the OR table. After general anesthesia was induced, the patient was turned over to the lateral decubitus position. The left upper extremity was prepped and draped in the usual sterile fashion. A standard posterior approach to the humeral shaft was performed. Dissection was carried down through the subcutaneous layer. The interval between the long and lateral heads of the triceps was identified and the triceps tendon was incised in the midline distally. Careful dissection was carried out to expose the radial nerve and the neurovascular bundle. This bundle was encased in a scar tissue and careful dissection was performed to free up the bundle from the eschar. Penrose drains were placed around the neurovascular bundle before the fracture was exposed. Next, the fracture callus was identified and taken down. The bone graft from the callus was saved for later bone grafting. Next, the humeral shaft nonunion was exposed and cleaned with a curette and rongeurs, after the fractured ends were thoroughly exposed. Next, a 12-hole LCDC plate was contoured to the posterior aspect of the humerus. Compression was obtained across the fracture. Four screws were placed proximal and four screws distal to the fracture. Compression was applied to eccentric positioning of the screws. After excellent reduction was obtained, bone graft from the callus was then packed around the fracture site. This was done after the wound was thoroughly irrigated with normal saline. Next, the fascia was closed with a running 2-0 Vicryl suture. The subcutaneous layer was closed with 3-0 Vicryl suture followed by staples for the skin. Sterile dressings were applied and the patient was then turned over to the supine position, extubated, and awakened from anesthesia. The patient was transferred onto a stretcher and taken to the PACU for recovery.
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