Outcome of Non-union Diaphyseal Fracture of the Humerus Managed by Ilizarov External Fixation

Open Access

Abstract

Introduction: Humeral shaft fractures are common in adults, and a subset progresses to established non-union, causing persistent pain, deformity, and functional limitation. Ilizarov circular external fixation offers stable fixation with minimal soft-tissue disruption and can address complex non-union, including infected cases, but local outcome data remain limited. Methods & Materials: Adults with established diaphyseal humeral non-union were enrolled consecutively at NITOR, Dhaka, from April 2023 to April 2025. Patients were followed until frame removal, with union assessed clinically and on AP and lateral radiographs, while shoulder ROM (goniometer), pain (VAS), and complications were recorded at predefined time points; results were summarised descriptively in SPSS v26.0. Result: Twenty-four adults with diaphyseal humeral non-union were included, evenly split between ages 21–30 and 31–55 years, and 58.3% were male. Infection-related non-union was the most common aetiology (62.5%), followed by implant failure (29.2%). Complications were infrequent, with pin tract infection and wire breakage each occurring in 4.2%, and any complication in 8.4%. Pain improved markedly over follow-up, shifting from predominantly severe at baseline (66.7%) to mostly pain-free by 12 months (66.7%) and 24 months (75.0%). Shoulder function also improved progressively, with all patients ≤30° at baseline, most exceeding 90° by 24 weeks (79.1%), and at 24 months, 50.0% achieving 91–130° and 37.5% exceeding 130° of motion. Conclusion: Ilizarov circular external fixation provided effective management of humeral shaft non-union, with low complication rates and sustained improvements in pain and shoulder range of motion. It appears to be a practical option for complex, including infection-related, non-unions when appropriate pin care and rehabilitation are maintained.