Humerus non-unions are difficult to treat, especially those with infected non-unions, bone loss, deformity, previous multiple surgeries and/or broken hardware. This paper presents our experience with the use of the Ilizarov frame with humerus non- unions. Eight consecutive humerus non-unions were treated using the Ilizarov frame. Only loose or infected hardware was removed. The Ilizarov frame was applied using safe zones principles of Ilizarov, Catagni and Paley. Aspetic non-unions were treated with deformity correction, sequential compression and distraction, bone grafting and intramedullary stabilisation for diaphyseal nonunions. Infected diaphyseal non-unions were treated intra-medullary reaming with or without excision of infected necrotic bone segment, followed by insertion of antibiotic cement rod and compression. Elbow spanning frames were avoided for supracondylar non-unions. Fine wire fixation of the distal fragment was preferred instead. Free elbow movement was allowed. There were two infected (diaphyseal) and six aseptic non-unions (four diaphyseal and two supracondylar) treated with this technique. Broken hardware was left in-situ in five cases. The average time from the index injury was 14 months, with each case having had an average of 3.2 procedures, prior to the application of the Ilizarov frame. Union was obtained in all cases. The average humerus shortening was 1.5 cm. There was no residual angular or rotational deformity. Infection was eliminated in both the infected non-unions. Primary bone grafting was used in all aseptic nonunions. Additional bone grafting was needed as a secondary procedure in four cases prior to frame removal. T he average time spent in the frame was 4.5 months. The Ilizarov method is a useful option for the management of complex humerus non-unions. Patients learn to tolerate the fixator and can achieve functional shoulder and elbow range with the fixator.
To identify ideal screw placement for internal fixation of intra capsular fracture neck of femur to avoid fixation failures, 20 cadaveric bone measurements of the neck of femur in basal, midcervical and at sub capital regions were carried out using Vernial caliper and CT scan. Midcervical region of neck of femur measurements were further divided into upper half (Superior half) and Inferior half (Inferior Half). AP and Lateral view X-rays were obtained following three parallel screws placements in Femur neck: Configuration 1: Triangular configuration where two screws are inferior and one superior. Configuration 2: Triangular configuration where two screws are placed superiorly and one screw inferiorly.
Neck has wider diameter in the upper half of neck of femur than in the lower half in the mid cervical region. Placing two 7.0 mm cancellous screws (total 14 mm) in the lower half of the neck of femur, as widely practised, has more likely chances of not having purchase in the mid cervical region of the femur neck by at least one screw. Cannulated screws fixation carried out in Reverse triangular configuration of fixation is also likely to support the weaker superior half of the neck which lacks stronger cortex and calcar part as in the inferior part of the neck We also recommend placing a larger screw in the superior half of femur neck and a smaller screw in the inferior half in recon-–IM nail fixation, based upon our experiment result.
