A Systematic Review in the Role of Ilizarov Fixator in the Treatment of Infected Non-United Distal Humerus Fractures in adults after Failure of Internal Fixation

Abstract

Distal humerus non-union is one of the most feared complications; although it can be painless and may not require treatment, in general it is characterised by marked instability, pain, strength loss and significant functional limitation . By searching through literature, limited studies were found evaluating the efficiency of the Ilizarov method in the treatment of infected nonunion of the distal humerus that have failed one or more prior attempts of open reduction and internal fixation. The Ilizarov fixator in treating patients with post-infection nonunion of the supracondylar area of the humerus can achieve good alignment of the bone with stable reduction and rigid fixation of the fracture, allows early mobilization. An adequate knowledge of the cross-sectional anatomy of the humerus is necessary to avoid neurovascular injury while placing the wires and pins of the Ilizarov fixator. Before applying the Ilizarov fixator, the humerus is exposed through a posterior approach. The ulnar nerve is explored. Then removal of retained hardware is done, debridement of the nonunion site to reach bleeding bone edges. Grafting the nonunion site by iliac bone graft followed by approximating and compressing the bone ends with wires. The range of motion of the elbow is increased gradually in accordance to the clinical and radiographic findings to reach at the end of the fixation period 70-100 % of the normal range of motion.