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What is Nonunion Fixation of a Shoulder Fracture?

Nonunion fixation of a shoulder fracture is a surgical procedure that is performed to repair a shoulder fracture that has persisted for at least 9 months and has not shown any signs of healing for 3 months. Nonunion fractures are generally complex fractures and the aim of nonunion fixation is the restoration of pain-free mobility and function.

Anatomy of the Shoulder Joint

The shoulder is a complex joint formed by the top of the arm bone (humerus) and the shoulder blade (scapula) as well as the end of the collar bone (clavicle) which connects to a bone projection on the scapula (acromion). The shoulder joint is surrounded by the rotator cuff which is a group of muscles and tendons that stabilize the joint while allowing a wide range of motion. A fracture of any of the bones that form the shoulder joint can significantly compromise shoulder function. 

Indications for Nonunion Fixation of a Shoulder Fracture

Nonunion fixation of a shoulder fracture is indicated in the following conditions:

  • There is a persistent gap present between the fractured ends of the bone on repeated imaging studies over several months.
  • There is persistent pain at the fracture site. 
  • There is inadequate healing of tissues in a time frame that should be enough for normal healing.

Preparation for Nonunion Fixation of a Shoulder Fracture

Your doctor will assess your symptoms and perform an examination. Imaging tests such as X-ray, MRI, or CT-scanning may be ordered. Inform your doctor about the medicines you are taking prior to the procedure, and if you are allergic to any medicines or anesthesia. Arrange for someone to drive you home after the surgery.

Procedure for Nonunion Fixation of a Shoulder Fracture

  • Either general or regional anesthesia can be used for the surgery.
  • An incision is made on the skin over the fracture site.
  • Healthy blood supply to the area is established by removal of bone fragments and poorly vascularized tissue from the area.
  • Bones are realigned to ensure adequate shoulder stability.
  • Bone cement is used to hold the bone's edges together.
  • Bone grafts may be used to stimulate healing between the broken bone edges.
  • Metal plates and screws are placed to hold bones in the correct position.
  • Soft tissue injuries to the ligaments and tendons will also be repaired during the surgery.
  • The incision is then closed with sutures.

Recovery after Nonunion Fixation of Shoulder

Prescription pain medicines or NSAIDs (non-steroidal anti-inflammatory drugs) are used to manage pain. Your shoulder will be placed in a sling for 4-6 weeks to immobilize the shoulder while it heals. Physical therapy will be recommended at the appropriate time to help you regain shoulder mobility. As the shoulder becomes stronger, you will be allowed to gradually return to routine activities. Most patients can expect to fully return to normal activities after 6 months.

Risks of Nonunion Fixation of a Shoulder Fracture

As with any surgery, there are associated risks and complications that may occur. Those related to nonunion fixation of a shoulder fracture may include:

  • Anesthetic complications
  • Infection
  • Nerve damage
  • Stiffness

Benefits of Nonunion Fixation of a Shoulder Fracture

Most patients are able to regain sufficient mobility and function in the shoulder to maintain an active lifestyle and perform routine activities of daily living with minimal or no discomfort.