Step-Cut Osteotomy for Recalcitrant Humeral Shaft Nonunion

The majority of humeral shaft nonunions resolve following operative intervention; however, a small percentage will persist despite surgical efforts. These cases of persistent nonunion are frustrating for patients and challenging for orthopedic surgeons. The authors describe the use of a step-cut osteotomy of the humeral diaphysis coupled with neutralization plating and autologous bone grafting for the management of humeral shaft nonunions that were recalcitrant to initial surgical management. In the authors' experience, this technique has been a valuable adjunct for obtaining adequate reduction and subsequent union in these complex cases.