Proximal Humerus Malunion & Nonunion
Persistent symptoms after a fracture may reflect how the bone healed—or whether it healed at all.
What is a malunion?
A malunion is a fracture that has healed in an altered position. Around the shoulder, the position of the humeral head and tuberosities can affect movement and tendon mechanics. An unusual X-ray alone does not require surgery; symptoms and function matter.
What is a nonunion?
A nonunion is failure of the fracture to unite. Persistent pain at the fracture site can be a clue, but diagnosis requires assessment over time and imaging. Stability, blood supply, infection, nutrition, and nicotine exposure can influence healing.
How the problem is evaluated
The evaluation usually starts with the injury history, treatment records, an examination, and current X-rays. CT can clarify bone position or healing when needed. Previous surgery, infection concerns, tendon function, and nerve symptoms may require additional investigation.
Bring earlier images—not just their reports—so the team can compare the course of healing.
Treatment follows the cause
Some patients improve with activity adjustments and targeted rehabilitation. Selected cases may benefit from corrective surgery, revision fixation with a plan to support bone healing, or shoulder replacement when reconstruction is not dependable. Infection requires its own diagnostic and treatment strategy.
The goal is meaningful improvement in pain and useful function, not simply a more normal-looking image. Revision treatment can be complex and should include a realistic discussion of risks, restrictions, and expected recovery.
When to seek prompt care
New deformity, marked worsening pain after another injury, a cold or numb hand, fever, or drainage after surgery needs timely assessment.