Twenty-year Delayed Failure of an Intramedullary Humeral Nail Due to Shaft Non-union and its Surgical Management: A Case Report

Introduction: Non-union following humeral shaft fractures is an uncommon yet disabling complication that may ultimately lead to implant failure in the presence of persistent mechanical instability. Delayed, non-traumatic breakage of an intramedullary nail several decades after fixation is exceedingly rare. Case Report: We report the case of a 44-year-old male who presented 20 years after primary intramedullary interlocking nailing for a humeral shaft fracture with progressive arm pain, functional limitation, established mid-diaphyseal non-union, and spontaneous nail breakage in the absence of new trauma. The patient was managed with a single-stage surgical procedure comprising implant removal, thorough debridement of the non-union site, open reduction and internal fixation using compression plating, and augmentation with autogenous iliac crest bone graft. The post-operative course was uneventful, and serial radiographs demonstrated progressive healing with solid union and restoration of function. Conclusion: This case highlights the importance of addressing both mechanical stability and the biological environment in the management of chronic humeral shaft non-union and supports single-stage nail removal followed by compression plating with autologous bone grafting as a reliable treatment strategy for rare late implant failures.