Circular frames of the humerus: salvage surgery case series
Introduction: High energy fractures like gunshot-related injuries or high velocity road traffic accidents are often complex to treat and have been associated with a higher non-union rate, especially when there is extensive bone loss. Fractures with severe comminution may not heal due to bone loss and an inability to achieve adequate fracture stability. Treatment of fractures that are not amenable to plating or nailing may lead to non-unions, septic or aseptic, that need repeat surgeries. Stabilisation with external fixation is a reliable option to maintain stability and provide a suitable environment for union.
Materials and methods: This retrospective study used medical records of all patients with complex mid-shaft humerus fractures, as well as their complications, that were treated with hexapod circular external fixation between January 2009 and September 2015. All the patients in this case series presented with severe humerus fractures or complications thereof which were not amenable to conventional therapy.
Results: Union was achieved in ten out of the 12 cases (83.3%). Union was achieved without bone graft or any other interventions at the fracture site except implant removal where indicated. The median time in external fixation was 196 days (interquartile range: 112–228). The most common complication encountered in this series was pin-site infection. Fixation points were noted to be infected in 33% of cases at some time during the treatment period.
Conclusion: This study suggests that humeral non-unions and complex humerus fractures that are not amenable to conventional fixation methods, such as intramedullary nails and plates, can successfully achieve union when treated with a hexapod circular external fixator.
Level of evidence: Level 4