Treatment of humeral shaft nonunion by exchange intramedullary nailing and circumferential cortical strut allograft: the Sarcophagus technique.

BACKGROUND: Nonunion of the humeral shaft presents a complex surgical challenge, with ongoing debate surrounding optimal fixation and grafting strategies. This study evaluates the clinical and radiographic outcomes of a novel surgical approach, intramedullary nailing combined with circumferential (360°) cortical strut allografting, termed the Sarcophagus technique. We hypothesized that the Sarcophagus technique would be a safe and effective treatment strategy for humeral shaft nonunion, offering union rates comparable to conventional techniques.

METHODS: We conducted a retrospective case series of 8 patients with aseptic, atrophic humeral shaft nonunion treated using the Sarcophagus technique between 2017 and 2021. All patients had previously undergone intramedullary nailing as the index treatment. The primary outcome was radiographic union at 12 months. Secondary outcomes included time to union, complication rates, and functional scores (American Shoulder and Elbow Surgeons, Simple Shoulder Test, Quick Disabilities of the Arm, Shoulder, and Hand, and Auto-Constant) assessed at 3, 6, and 12 months.

RESULTS: Radiographic union was achieved in 7 of 8 patients (87.5%), with a mean time to union of 5.8 ± 1.3 months. Functional outcomes demonstrated progressive improvement across all measures during follow-up. No post-operative infections occurred. One patient had persistent fracture nonunion but remained minimally symptomatic and declined re-revision. Transient radial nerve palsy occurred in 1 patient (12.5%) and resolved spontaneously within 3 months.

CONCLUSION: The Sarcophagus technique demonstrated a high union rate and favorable functional recovery in patients with humeral shaft nonunion. Larger comparative studies are warranted to further establish the role of this technique in complex humeral nonunions.