Salvage of contaminated fractures of the distal humerus with thin wire external fixation

Fractures and osteotomies of the distal humerus that are contaminated or in fected represent a difficult management problem, Stable anatomic fixation w ith plates and screws, the acknowledged key to a good result in the treatme nt of bicondylar fractures, may be unwise, A thin wire circular (Ilizarov) external fixator was used as salvage treatment in such complex situations i n five patients, The fixator allowed functional mobilization of the elbow w hile allowing achievement of the primary goal of eradicating the infection or colonization. Two patients required a second operation for fixation of a fibrous union of the lateral condyle, One patient with a vascularized fibu lar graft later required triple plate fixation for malalignment at the dist al host and graft junction, Four of five patients ultimately achieved compl ete union. The fracture remained ununited in one patient who has declined a dditional intervention, All five patients achieved at least 85 degrees ulno humeral motion, two after a secondary elbow capsulectomy performed after he aling was achieved. This experience suggested that the Ilizarov construct, although not a panacea, represents a reliable method of skeletal stabilizat ion that allows functional mobilization while elimination of infection or c olonization is ensured. If necessary, stiffness and incomplete healing can be addressed with an increased margin of safety at subsequent operations.