Background: Atrophic nonunion of the humerus is a challenging condition, especially following failure of conventional fixation methods such as the AO external fixator for open fractures. The Ilizarov technique provides a biologically favourable mechanical environment for bone healing in such complex cases. Case Presentation: A 35-year-old male presented with atrophic nonunion of the midshaft humerus, six months after a failed AO external fixator application for an open humerus fracture. The patient had a restricted range of motion, pain, and functional disability. Radiographs revealed hypertrophic callus absence and a significant bone gap. The patient was managed with a hybrid Ilizarov external fixator incorporating both Schantz pins and half rings for optimal stability. Union was achieved at 4 months. Conclusion: This case highlights the utility of hybrid Ilizarov fixation in complex nonunions, the critical role of accurate classification using Weber-Cech and Paley systems, and the importance of restoring both mechanical and biological environments for bone healing. Hybrid Ilizarov fixation offers a viable salvage treatment for atrophic nonunion of the humerus, especially after failure of previous fixation. It provides stable fixation, stimulates osteogenesis, and allows early rehabilitation.
Ahmed et al. (Sun,) studied this question.