Ilizarov treatment of humeral shaft nonunion in an antiepileptic drug patient with uncontrolled generalized tonic-clonic seizure activity

Abstract

Nonunion of the humeral shaft in patients with antiepileptic drug associated metabolic bone disorder constitute a challenging surgical problem difficult to treat due to seizure activity, osteoporosis, and poor stabilization options. We report a case of nonunion of the humeral shaft in an antiepileptic drug patient with uncontrolled generalized tonic-clonic seizure activity successfully treated with Ilizarov external fixator and a follow-up of 4 years.

Figure 1

Anteroposteriorradiograph of the right humerus of a 43-year-old man sustained a transverse diaphyseal fracture after a fall during a generalized tonic-clonic attack.

Figure 2

Lateral view of the right humerus.

Figure 3

Anteroposteriorradiograph of the right humerus showing atrophic nonunion of the humeral shaft 18 months after treatment with open reduction and internal fixation.

Figure 4

Lateral view of the right humerus 18 months postoperatively.

Figure 5

Radiograph of the3-ring frame.

Figure 6

Photograph of the same Ilizarov circular frame. Note the proximal and distal 5/8 rings that facilitate active shoulder and elbow range of motion.

Figure 7

Anteroposteriorradiograph of the humeral fracture 4 years after surgery. Union was achieved 4.5 months after initial application of the frame.

Figure 8

Lateral view of the humeral fracture 4 years postoperatively.