• Vol. 38 No. 12, 1090–1094
  • 15 December 2009

Infected non-union of the Humerus after Failure of Surgical Treatment: Management using the Orthofix External Fixator



Introduction: 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. Materials and Methods: We treated 8 infected non-union of diaphyseal fracture of the humerus by the Orthofi x 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. Results: 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. Conclusion: 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 immobilisationwith moderate functional recovery.

The incidence of non-union after operative treatment of humeral shaft fractures has been reported to range between 2.5% and 13%.1-4 While a number of methods of managing atrophic ununited fractures with bone defects have been suggested, each has its drawbacks. Grafts of cortical bone revascularise slowly and incompletely. There is a substantial risk of infection, delayed union and non-union, and fractures through the graft are common.5-10

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