The use of external fixation in the treatment of nonunion and malunion of the upper extremity.

Abstract

Nonunion and malunion of upper extremity fractures are uncommon but challenging complications, particularly when associated with infection, deformity, or multiple previous operations. Although internal fixation remains the standard treatment, external fixation based on Ilizarov principles offers advantages in complex situations including infection control, deformity correction, and gradual bone reconstruction. This study evaluates the indications, surgical technique, and outcomes of external fixation as a definitive treatment for nonunion and malunion of the upper extremity. A retrospective study was conducted including patients treated for nonunion or malunion of humeral and forearm fractures using external fixation as the definitive method of treatment. Hybrid or circular frames were applied according to fracture location. Corticotomy and gradual deformity correction were performed following the principles of Ilizarov and the law of tension-stress. Patients were evaluated clinically and radiographically for union, deformity correction, pain, function, and complications. A total of 45 patients were included, consisting of 7 malunions, 8 aseptic nonunions, and 30 septic nonunions. Patients' ages ranged from 6 to 62 years. The mean time from injury to definitive treatment was 29.7 months. The average external fixation time was 7.9 months and mean follow-up was 38.7 months. Complete radiological union was achieved in all cases. Mechanical alignment was restored in most patients, with minor residual humeral varus (<10°) in five cases. The mean VAS pain score was 2.1 and mean patient satisfaction score was 8.7. Superficial Pin-tract infection occurred in patients but was successfully managed with local care and antibiotics. External fixation using Ilizarov principles represents an effective promising and reliable treatment for upper extremity nonunion and malunion. It allows simultaneous infection control, deformity correction, and bone healing without the need for bone grafting, particularly in complex cases with poor bone stock or multiple previous operations.