Ilizarov′s method for treatment of nonunion of diaphyseal fractures of the humerus

Abstract

Background:Nonunion in diaphyseal fractures of the humerus can be treated by various modalities like plating and bone grafting, exchange nailing, fibular strut grafting and Ilizarov’s method of ring fixation. To achieve union in infected nonunion in which multiple surgeries have already been done is further challenging. We conducted a prospective study wherein the outcome of the treatment of nonunion of diaphyseal fractures of the humerus by Ilizarov’s method was analyzed.Materials and Methods:Nineteen patients with diaphyseal nonunion of the humerus were treated by Ilizarov’s external fixator. These included nonunion after plating (n=11), intramedullary nailing (n=1) or conservative methods (n=7). In post-surgical infected nonunion (n=6), the implants were removed, debridement done, bone fragments were docked followed by application of ring fixator and compression. In aseptic nonunion (n=13), distraction for three weeks followed by compression was the protocol. Early shoulder and elbow physiotherapy was instituted. The apparatus was removed after clinical and radiological union and the results were assessed for bone healing and functional status.Results:Fracture union was achieved in all the 19 cases. Pin site infection was seen in 2 cases (10.52%). The bone healing results were excellent in eighteen cases (94.73%) and good in one case (5.26%).The functional results were found to be excellent in fourteen cases (73.68%), good in four (21.05%) and fair in one case (5.26%).Conclusion:Ilizarov’s method is an excellent option for treatment of septic and aseptic non union of diaphyseal fractures of the humerus as it addresses all the problems associated with non union of the humerus like infection, deformity and joint stiffness.

Locking compression plate in humeral shaft nonunion: a retrospective study of 18 cases

“…Ten patients (56%) were treated by traditional bone setters, eight (44%) patients had some form of internal fixation, (nails=2, LCP=4, DCP=2). The mean duration of nonunion was 18.3 months (range [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. In patients treated by traditional bone setters seven had atrophic type, two had gap nonunion, one had pseudoarthrosis.…”

“…The disadvantages are bulky implant, pin tract infection, painful impingement of the frame on the chest wall and possibility of neurovascular injury due to improper placement of wires. 20,21 LCP has a unique advantage as it can be used in the treatment of nonunion in patients with osteoporosis and in patients who had any form of internal fixation as the index procedure. Screw holes made previously by index procedure may interfere with the subsequent purchase of screws, but LCP can overcome this advantage.…”

Outcome of Humeral Shaft Infected Non-Unions, Treated with Orthofix External Fixator

“…Outcome of treatment for infected non-union has been reported in only four reports. [1][2][3][4] Only two of these describe results of infected nonunion exclusively in 1997 and 2009. 1,4 We retrospectively reviewed a consecutive case series of infected non-union of humerus.…”

“…[1][2][3][4] Only two of these describe results of infected nonunion exclusively in 1997 and 2009. 1,4 We retrospectively reviewed a consecutive case series of infected non-union of humerus. We had 17 patients, out of which seven patients underwent staged debridement followed by intramedullary strut grafting, internal fixation and autogenous bone grafting.…”

Infektpseudarthrosen

“…Die Pseudarthrosenrate an langen Röhrenknochen wird mit bis zu 48% angegeben [5,7,15,25,29,43,60,62,72], die der Infektpseudarthrose mit bis zu 15% [41,47,74]…”