[Treatment of fractures of the humeral shaft using Hoffman's external fixator]

Thirty-nine patients treated with the Hoffman external fixator for a diaphyseal fracture of the humerus, were clinically and radiologically assessed with an average follow-up of 3.2 years. Open fractures, failure of a previous treatment, secondary displacement, and polytraumatisms were the usual indications for external fixation. Clinical bone healing was obtained within an average delay of 10.5 weeks. One patient underwent a pseudarthrosis. Six patients with secondary displacement of the fracture were operated on again, and the fracture was easily reduced by simple manipulation of the device under general anesthesia. The enclosing of the fractured extremities statistically diminished the risk of secondary displacement. Twenty CT scan examinations were performed to assess the occurrence of rotational malunion. Fourteen patients were malunited in internal rotation of the distal fragment with an average diminution of the retrotorsion of 19.4 degrees. No iatrogenic vascular or neurological complication occurred. The Hoffman external fixation does not replace the orthopedic treatment of the diaphyseal fractures of the humerus. It is simple to use and ensure satisfactory contention of the fractures' extremities when they are enclosed. If a secondary displacement occurs, it is simple to modify the device to reduce the fracture. If necessary, an additional surgical procedure, such as cancellous bone grafting or radial nerve repair, can be performed without modification of the osteosynthesis.