Comparison of surgical techniques for the treatment of humeral nonunion using the Ilizarov method

In the case of humeral shaft aseptic nonunions treatment with the Ilizarov apparatus can achieve optimal results. We included 21 patients (10 females and 11 males), who underwent posttraumatic humeral nonunion treatment at the Orthopedics and Musculoskeletal Trauma Surgery, Medical University of Warsaw, in the period between 2011 and 2023. Patient age ranged from 21.0 to 68.0 years, with a median age of 42.3 years. Clinical and radiological pre- and postoperative records were collected, including the radiological Weber and Pech and Paley classifications, as well as questionnaires validated in Polish, such as the Shoulder Strength Index, the University of California-Los Angeles (UCLA) Shoulder Scale, and the Constant Score. Study evaluated the duration of treatment with an Ilizarov apparatus, the rates of achieved and maintained bone union, changes in questionnaire scores and the radiological and functional outcomes measured with an Association for the Study and Application of the Method of Ilizarov scoring systems. All methods were carried out in accordance with available relevant guidelines and regulations.The study protocol was approved by the Supervisor of the WUM Department and the Warsaw Medical University. Informed consent was obtained from each patient. 90% of patients achieved bone union maintained during 12-month follow-up. The ASAMI scores reveal that the majority of patients achieved 'very good' outcomes. The median UCLA scores improved from 11.0 to 31.0 (p < 0.001), the Constant scores rose from 28 to 94 (p < 0.001), the SSI-ASES scores demonstrated increases from 43 to 95 (p < 0.001). The most common complications were Kirschner wire-track infections (8 cases). The use of the Ilizarov apparatus is recommended in patients with coexisting nonunion and ones with bone segment deformity or shortening. The preferred closed reduction approach is dedicated for patients with chronic conditions in whom an open approach might result in delayed surgical wound healing or surgical site infection.