title: Ilizarov treatment of infected nonunions of the distal humerus after failure of internal fixation: an outcomes study.
abstract: OBJECTIVE
  To report the functional outcomes of Ilizarov treatment of infected nonunion of the distal humerus.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Between July 1998 and August 2003, 6 consecutive patients (age 33 to 73 years) were referred to us with an infected nonunion of the distal humerus following failure of open reduction and internal fixation. The average time from initial injury to presentation with the nonunion was 27 months (range, 6 to 99 months). The average number of prior surgeries was 2.8 (range, 1 to 4).
  
  
  METHODS
  Hardware removal, ulnar nerve neurolysis, 1 stage debridement, autogenous bone grafting, and application of an Ilizarov external fixator with acute compression in the operating room followed by slow gradual compression (0.25-0.50 mm per day) for several weeks postoperatively.
  
  
  METHODS
  Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; SF-12 Physical Component Scale (PCS); Brief Pain Inventory; quality-adjusted life years.
  
  
  RESULTS
  All patients attained bony union. One patient refractured 3 weeks after removal of the external fixator following a fall and ultimately underwent total elbow arthroplasty. At an average follow-up of 4.1 years (range, 2 to 7 years), none of the remaining 5 patients had undergone any additional surgery on their arm and all were free of infection. For these 5 patients, significant improvements were seen in standardized DASH scores (42% initially to 78% at follow-up, P = 0.017), worst pain intensity ratings (5.4 initially to 0.8 at follow-up, P = 0.007), and SF-12 PCS scores (37 initially to 44 at follow-up, P = 0.041). On average, the pretreatment to posttreatment improvement was equivalent to 3.8 quality-adjusted life years.
  
  
  CONCLUSIONS
  Ilizarov treatment of infected distal humeral nonunions that have failed internal fixation restores function, decreases pain, and improves quality of life. The Ilizarov method should be considered a primary treatment option for this disabling and difficult clinical problem.
authors.affiliation: Center for Problem Fractures and Limb Restoration, Houston, TX 77030-4509, USA. mb53@fondren.com
authors.forename: Mark R
authors.initials: MR
authors.lastname: Brinker
authors.forename: Daniel P
authors.initials: DP
authors.lastname: O'Connor
authors.forename: C Craig
authors.initials: CC
authors.lastname: Crouch
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Mehlhoff
authors.forename: James B
authors.initials: JB
authors.lastname: Bennett
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D018889:Ilizarov Technique; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000145:classification*; D011446:Prospective Studies; D011859:Radiography; D014946:Wound Infection / Q000382:microbiology*