Staged Management of a Gustilo-Anderson Type IIIB Open Humeral Shaft Fracture Using the Ilizarov Method Followed by Definitive Internal Fixation: A Case Report

Open Access

Abstract

Background: Managing Gustilo-Anderson Type IIIB open humeral shaft fractures in resource-limited settings requires a staged external-to-internal fixation strategy to control infection and achieve soft-tissue coverage before definitive reconstruction. Case Description: A 15-year-old male presented with an infected Type IIIB open right humeral fracture three days after a stone-crusher injury. Treatment involved radical debridement and Ilizarov ring fixation using tensioned olive wires, followed by split-thickness skin grafting at one month. Although robust calluses were visible at 3.5 months prompting frame removal, premature heavy labor caused an acute closed refracture two days later. Results: Following 21 days of plaster immobilization, the closed refracture was definitively stabilized using an 8-hole plate and screws. Complete osseous union was achieved, allowing full recovery and return to work. Conclusion: Initial Ilizarov fixation for infection control and soft-tissue salvage, followed by plate osteosynthesis for mechanical failure, is an effective salvage protocol for severe open upper-extremity trauma.