Ilizarov treatment may be viable option for post-infection nonunion of supracondylar humerus

Safoury AY. J Shoulder Elb Surg. 2011. doi:10.1016/j.jse.2011.04.021

Post-infection nonunion of the supracondylar humerus can be effectively and reliably managed through the Ilizarov treatment, according to Egyptian researchers.

The team followed eight patients who underwent the Ilizarov treatment for post-infection nonunion of the supracondylar area of the humerus, with a final follow-up of 3 years. The patients had a mean overall age of 45.73 years, with each having undergone at least two previous failed operations.

Radiological and clinical evaluations were performed, and the Disabilities of the Arm, Shoulder and Hand (DASH) score was used to measure outcomes.

According to the study results, all patients displayed union in a mean 6.87 months, with postoperative improvements in shoulder and elbow motion. Preoperative DASH score averaged around 90.66, with postoperative DASH scores averaging 24.62 — a finding the researchers labeled significant.

“All patients were satisfied with the treatment and returned to a more normal lifestyle with no pain, as well as complete soft tissue recovery,” the authors wrote. “None had recurrence of infection.”

I think it's a well written article. The approach to this complex issue was well thought out. I think that the number of patients is small; however, I also understand that it's difficult to put these cases together due to its rarity. It's important the versatility of the external fixator is used and tolerated by the patients. Also important are the findings regarding the shortening of the humerus and the good results obtained, which goes against the classic thought.

I think that the outcome achieved is good and overall this treatment could be recommended. Of course we have to bear in mind that being an uncommon pathology, each case should be treated individually.

— Juan Pretell, MD
Madrid, Spain