Infected non-union of the humerus after failure of surgical treatment: management using the Orthofix external fixator

ABSTRACT

<p><b>INTRODUCTION</b>The failure of a humeral fracture to unite after surgical treatment may be due to many factors. When there are additional complications of infection, treatment by conventional methods of internal fixation becomes very difficult.</p><p><b>MATERIALS AND METHODS</b>We treated 8 infected non-union of diaphyseal fracture of the humerus by the Orthofix external fixator. All had previous surgical treatment. Non-union followed plating in 6 cases and in 2 cases after the external fixator. All patients had pain, at least one sinus discharging pus and severe functional impairment of the affected arm. There were 6 men and 2 women with a mean age 40.6 years.</p><p><b>RESULTS</b>Bone union was achieved in all cases. The mean time to union was 4.5 months (range, 2 to 8). Patients expressed high levels of satisfaction with the outcome, despite relatively modest improvement in pain and function, mainly because of long standing infection and intractable non-union. There were no major pin tract problems requiring the removal of the Schanz screws. Radial nerve palsy developed in 1 patient who recovered spontaneously. No patient required an additional bone grafting procedure.</p><p><b>CONCLUSION</b>The use of the Orthofix external fixator without bone grafting was successful in the treatment of infected non-union of the humeral shaft. It shortened the duration of hospitalisation and immobilisation with moderate functional recovery.</p>