NONUNION OF THE HUMERUS FOLLOWING INTRAMEDULLARY NAILING TREATED BY ILIZAROV HYBRID FIXATION

A case of a posttraumatic humeral shaft nonunion, after intramedullary stabilization with a Seidel nail, is presented. Severe osteoporosis, an oligotrophic nonunion, subclinical infection, and adhesive capsulit is of the glenohumeral joint were present. Due to the subclinical infe ction and severe osteoporosis, other major invasive therapeutic option s such as intramedullary nailing or compression plating and bone graft ing were not applicable. Nonoperative treatment was also not indicated secondary to the pain and disability present. External fixation with the Ilizarov hybrid fixator seemed to offer a minimally invasive treat ment modality without the need of additional bone grafting. After four teen weeks of ''callus massage,'' consisting of closed alternating com pression and distraction with an Ilizarov hybrid fixator, osseous cons olidation was achieved. Eight months after Ilizarov treatment the pati ent had returned to work as a mechanic. At the one-year follow-up exam ination, the patient presented pain free and with near normal shoulder and elbow motion, with stable osseous consolidation of the humerus. I n some cases of nonunion of the humerus shaft, when standard treatment options are not recommended, external fixation with an Ilizarov hybri d fixator may offer a salvage procedure with a successful clinical out come.