Case 103: Humerus Nonunion Treated with Fixator Augmented Rod Technique

Abstract

Nonunion of a humerus shaft fracture after repeatedly failed surgical attempts at bone healing presents a difficult therapeutic problem especially in the presence of osteoporosis, bone defect, and joint stiffness. The incidence of nonunion of humeral shaft fractures is reported as 2–10 % when managed conservatively and around 15 % when managed by open reduction and internal fixation (Pugh DM, McKee MD, J Am Acad Orthop Surg 11:48–59, 2003). The use of external fixation (unilateral or modified Ilizarov) augmented by IM rods together with the routine use of ICBG is a viable option to treat humeral shaft nonunion following failed implant surgery (Patel VR, Menon DK, Pool RD, Simonis RB, J Bone Jt Surg Br 82:977–983, 2000). The proposed technique improves stability of fixation and meanwhile minimizes the operative complications. The IM rod is left in situ after fixator removal to act as a permanent splint to shorten the external fixator time and prevent refracture after fixator removal (El-Rosasy MA, Indian J Orthop 46:58–64, 2012).