Distal humerus nonunions after failed internal fixation: Treatment with Ilizarov external fixator

Introduction/Objective Nonunions of the distal humerus after unsuccessful surgical treatment represents a challenging surgical problem. The complexity of this condition is increased by bone atrophy, scar tissue, poorly vascularized bone fragment, limited elbow mobility, osteomyelitis, and local neurological damage. The advantages of using the Ilizarov external fixation method are stable fixation, adequate fracture reduction, and fragment compression accompanied by minimal soft tissue trauma, with the possibility of early elbow mobilization. This aim of this paper is to present the treatment results of 19 patients with nonunion of distal humerus after internal osteosynthesis managed by the Ilizarov external fixation method. Methods Nineteen consecutive patients were treated with the Ilizarov external fixator. The study group includes 11 male and eight female patients with an average age of 42 years. Surgical technique consisted of approaching the nonunion, removing loose fixation material, making resection and debridement of bone fragments, after which the Ilizarov fixator was placed. Rehabilitation of the elbow started in the early postoperative period. The functional status of the arm was evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) score. Results All the patients achieved solid bony union after an average of seven months from the application of the external fixator. In 17 patients radiographic analysis indicated the preservation of joint space, while two showed degenerative changes. All the patients showed improvement in elbow range of motion and significantly better DASH score with postoperative value of 21. Conclusion As a treatment of distal humerus nonunion, the Ilizarov external fixation method provides successful healing and increased range of motion in the elbow. Keywords: humerus; nonunion; Ilizarov technique.