Hybrid Ilizarov’s Method and Fibular Strut for Humeral Diaphyseal Nonunion: A Case Report after Multiple Failed Plating

Author(s): Sujan Shakya, Roshan Lal Shrestha, Shikshya Prakash Shrestha, Niraj Shrestha, Umesh Bahadur Bogatee, Anil Shakya

Humeral diaphyseal fracture with non-union and failed implant in situ is a complex case. It is more challenging when the case is accompanied by infection, multiple ORIF, and osteopenic bone. Smoking and alcohol consumption synergically enhances delay in fracture healing and nonunion. The various surgical procedures are prevalent and conducted by orthopedic surgeons for its management. We hereby present a complex case of non-union humeral shaft fracture with an implant in situ by the use of autologous fibula strut as a biological nail to fit the non-union gap stabilized by K-wire and hybrid Ilizarov’s external fixator for mechanical support in a single setting. During this process, radical bone debridement was done. At 9 months of follow-up, bone union was achieved and the implants were removed. The final functional outcome was graded as good according to QuickDASH shoulder score with improved shoulder and absence of pain at the non-union site.