{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T18:21:10Z","timestamp":1781374870685,"version":"3.54.1"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12]]},"abstract":"\n OBJECTIVES:<\/jats:title>\n To determine the rate of successful humeral shaft nonunion repair in patients with no prior surgery on the humerus (failed nonoperative management), compared with patients with a history of surgery on the humerus (initial operative treatment complicated by nonunion, or prior attempted nonunion repair after failed nonoperative management).<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Retrospective.<\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n Two academic trauma centers (1 level 1 and 1 level 2).<\/jats:p>\n <\/jats:sec>\n \n Patient Selection Criteria:<\/jats:title>\n All skeletally mature patients undergoing nonunion repair of a presumed aseptic humeral shaft nonunion (AO\/OTA 11A, 11B, 11C, 12A, 12B, 12C) were eligible for inclusion.<\/jats:p>\n <\/jats:sec>\n \n Outcome Measures and Comparisons:<\/jats:title>\n The primary outcome was osseous union. Univariate analysis was used to examine patient, injury, and treatment factors associated with recalcitrant nonunion between those with and without prior surgery.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n One hundred fifty-nine patients were included. Eighty-two patients had a history of operative treatment. The group with prior operative treatment was significantly younger (47 vs. 52,\n P<\/jats:italic>\n = 0.047) and had fewer comorbidities (average Charlson comorbidity score 1.3 vs. 1.9,\n P<\/jats:italic>\n = 0.015). There were 34 men in the group with prior operative treatment, compared with 37 in the group without prior operative treatment (\n P<\/jats:italic>\n = 0.493). For patients with prior operative treatment, 17 of 82 (21%) patients developed a recalcitrant nonunion, versus 2 of 79 (3%) patients with no prior operative treatment (\n P<\/jats:italic>\n < 0.001). The number of prior operations on the arm was significantly associated with increased risk of recalcitrant nonunion (3% risk if no prior surgeries, 19% risk with 1 prior surgery, 25% risk with 2 prior surgeries, 33% risk with 3 prior surgeries,\n P<\/jats:italic>\n = 0.004). No demographic factors were associated with development of a recalcitrant nonunion (\n P<\/jats:italic>\n > 0.05 for all). Nine patients had unexpected positive cultures, but this was not associated with increased risk of recalcitrant nonunion (22% in patients with infection vs. 26% in those without infection,\n P<\/jats:italic>\n = 0.907).\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Patients undergoing nonunion repair after prior operative treatment of a humeral shaft fracture had a 1 in 5 rate of recalcitrant nonunion, while patients undergoing initial nonunion repair after failed nonoperative management had a 3 in 100 rate of recalcitrant nonunion. Increased risk of persistent nonunion stemmed not from initial treatment strategy for the acute fracture, but rather from the presence of any prior surgery.<\/jats:p>\n <\/jats:sec>\n \n LEVEL OF EVIDENCE:<\/jats:title>\n Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/bot.0000000000003065","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T19:00:13Z","timestamp":1756839613000},"page":"667-674","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Healing the Humeral Shaft Nonunion: Prior Surgery Confers Increased Risk of Recalcitrant Nonunion"],"prefix":"10.1097","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9229-745X","authenticated-orcid":false,"given":"Erika","family":"Roddy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Firoozabadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daphne","family":"Beingessner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Barei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20251204","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1097\/BOT.0000000000002740","article-title":"Outcomes of humerus nonunion surgery in patients with initial operative fracture fixation","volume":"38","author":"Harrison","year":"2024","journal-title":"J Orthop 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nonoperative vs operative treatment of humeral shaft fractures: a retrospective study of 213 patients","volume":"33","author":"Denard","year":"2010","journal-title":"Orthopedics"},{"key":"R9-20251204","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1016\/j.jse.2017.07.001","article-title":"Humeral shaft fractures: union outcomes in a large cohort","volume":"26","author":"Harkin","year":"2017","journal-title":"J Shoulder Elbow Surg"},{"issue":"suppl 2","key":"R10-20251204","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/s12306-017-0509-5","article-title":"Why a surgically treated humeral shaft fracture became a nonunion: review of 11 years in two trauma centers","volume":"101","author":"Maresca","year":"2017","journal-title":"Musculoskelet Surg"},{"key":"R11-20251204","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1016\/j.jseint.2020.06.009","article-title":"Risk factors for nonunion after traumatic humeral shaft fractures in adults","volume":"4","author":"Olson","year":"2020","journal-title":"JSES Int"},{"key":"R12-20251204","doi-asserted-by":"crossref","first-page":"e227","DOI":"10.1097\/BOT.0000000000002315","article-title":"Factors associated with patient-reported outcomes following a humeral shaft fracture: nonunion results in a poorer outcome despite union after surgical fixation","volume":"36","author":"Oliver","year":"2022","journal-title":"J Orthop Trauma"},{"key":"R13-20251204","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1001\/jamasurg.2021.0906","article-title":"Outcomes with surgery vs functional bracing for patients with closed, displaced humeral shaft fractures and the need for secondary surgery: a prespecified secondary analysis of the FISH randomized clinical trial","volume":"156","author":"Ramo","year":"2021","journal-title":"JAMA Surg"},{"key":"R14-20251204","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/S0736-0266(01)00142-5","article-title":"Human atrophic 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necessary?","volume":"42","author":"Ramoutar","year":"2011","journal-title":"Injury"}],"container-title":["Journal of Orthopaedic 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