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ILIZAROV TREATMENT OF INFECTED NON-UNIONS OF THE HUMERAL SHAFT

St. Peter’s Hospital, Chertsey, Surrey

Purpose of Study We present a method of treating these infected humeral shaft non-unions with an open debridement procedure followed by stabilisation with the Ilizarov frame.

Materials Thirteen infected non-unions of the humerus in adult patients have been treated by this method. Ten patients have completed their treatment and three are still undergoing treatment.

The site of the non-union is approached through the pre-existing scar and any remaining metalwork is removed. The ends of the non-union are mobilised and bone is resected from both ends until there is fresh bleeding. The two bone ends are fashioned such that one will fit as a spike inside the medullary cavity of the other. The bone ends are held in position with two temporary K wires until the frame has been applied.

A standard four ring Ilizarov frame is applied with Rancho pins in the proximal humerus and a half ring in the distal humerus. The temporary K wires are removed and the frame is compressed to increase the contact between the bone ends. The routine hospital stay is one week and the patients are given intravenous antibiotics throughout their admission.

They are reviewed in the outpatient clinic at monthly intervals and the frame is used to compress the bone ends by two to three millimetres on each visit. When there are radiographic signs of union the frame is removed under a general anaesthetic.

Results Nine of the ten patients who have completed their treatment have gone on to union in a mean of 8.25 months with a good functional result. Unfortunately three patients had transient radial nerve palsies.

Conclusions This technique has achieved union and eradication of infection in nine out of ten patients in whom all other forms of treatment had failed.

Correspondence should be addressed to The Secretary, British Elbow and Shoulder Society, The Royal College of Surgeons of England, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.