Surgical treatment of nonunions of the surgical neck of the humerus.

End-to-end alignment of the fragments usually does not provide good bone contact or stability for fractures of the surgical neck of the humerus because cavitation of the head fragment and comminution constitute bone stock deficiency. Painful and disabling nonunion of the surgical neck of the humerus in five patients was repaired by impaling one fragment into the other, usually the shaft into the head. A corticocancellous iliac graft bridged the nonunion by extending from the interior of the head to the shaft, where it was fixed by screws. Rush rods were used for internal fixation. All five patients obtained union without evidence of avascular necrosis during the period of observation (12 to 39 months), had good pain relief, and regained satisfactory function.