Nonunion of the humerus after failure of surgical treatment

Abstract

W e used the Ilizarov circular external fixator to treat 16 patients with persistent nonunion of the diaphysis of the humerus despite surgical treatment. All patients had pain and severe functional impairment of the affected arm. In ten, nonunion followed intramedullary nailing. We successfully treated these by a closed technique. The nail was left in place and the fracture compressed over it. The fractures of the other six patients had previously been fixed by various methods. We explored these nonunions, removed the fixation devices and excised fibrous tissue and dead bone before stabilising with the Ilizarov fixator. In five patients union was achieved. Bone grafting was not required. In the single patient in whom treatment failed, there had been a severely comminuted open fracture. All except one patient had reduction of pain, and all reported an improvement in function.

Initial Surgical Treatment of Humeral Shaft Fracture Predicts Difficulty Healing when Humeral Shaft Nonunion Occurs

“…Only 1 author has used the VAS to assess pain. Patel et al used the VAS for pain to evaluate repair of 16 diaphyseal humeral nonunions using an Ilizarov circular external fixator and reported a final VAS score of 2.5 at the end of treatment [4]. This is comparable to results we achieved in this study using plate and screw constructs.…”

Non-union of the humeral shaft treated by internal fixation

“…These include compression plating and bone grafting [1,3,4,5,6,12,13], intramedullary nailing [2], vascularised fibular grafting [7] and Ilizarov external fixator [9]. We are presenting our results of open reduction and internal fixation using a dynamic compression plate (DCP) with cancellous bone grafting in non-union of the humeral shaft.…”

Nonunion of the tibia following intramedullary nailing treated by Ilizarov external fixator: A case report

“…Treatment of aseptic nonunions by applying Ilizarov external fixator over intramedullary nail is a relatively new technique, not sufficiently explored yet. Very few researchers used the technique on limited number of cases, with published successful results (Patel et al, 2000;Menon et al, 2002;Brinker and O'Connor, 2003). It is possible in the method either to apply Ilizarov external fixator over the intramedullary nail that has originally been placed by keeping the nail in its position, or fixator may be applied by replacing the original nail with another nail having a smaller diameter (Brinker and O'Connor, 2003).…”