The person in the post does write like a surgeon.
I too was quite taken by the long plate along the humerus. I too agree that an intramedullary nail would have been optimal adequate fixation and bone healing with minimum disturbance at the fracture site. This is why most long bone fracture are being fixed in this manner once this is a feasible option, MM's fracture being one. The only thing rationale I'd imagine behind the long plate and many screws, was that they wanted him to mobilize early, believing that the construct would hold, allowing an early race return. This I thought very unwise and the same was for Lorenzo with his clavicular #. I thought Lorenzo was playing with fire and he got away with it. MM didn't.
When the plate broke, I thought.. oh dear. The more they mess with the bone ends, periosteum and fracture site, the more likely he is to suffer a non-union,.... which he did (they mentioned him having a pseudoarthrosis which is the what happens when the bone ends completely fail to heal). This was a freakish situation under the circumstances.
The bone grafting they did was fancy and the reason for all the time they took. The harvested bone is taken with attached muscle and blood vessels that supply the bone. Those vessels (vein and two arteries) or pedicle are then attached to vessels within his arm so that the graft has its own blood supply, maximising the chances of healing. The more common graft is avascular or without a pedicle and they did not wish to take chances with that option and I can understand that for sure.
Good luck to MM. I suspect there's a lot happening behind the scenes and the surgeon involved may have been asked to do the most rigid and sturdy fixation he could to allow for an early return to his riding. Unfortunately, this had its downside and MM is unfortunately living it in full.
