Unexpected resolution of a pseudoarthrosis after humeral fracture with unilateral fixator

Pseudoarthrosis generally develops after a bone fracture as the result of intrafragmentary micromobility with tissue damage, hypoxia and metaplasia of the mesenchymal cells into firbo-cartilaginous tissue. The fibrous tissue characteristic of a pseudoarthrosis can, however, be consolidated under maximum stabilization and compression. A 38-years-old woman fell accidentally and was admitted to our department with a compound fracture of the middle third of the left humeral shaft.. Fifteen years earlier, she had fracture the upper medial third of the same bone. Although a plaster cast had been applied, a pseudoarthrosis had developed at that level. We applied a unilateral humerous fixator to treat both situations simultaneous. The fracture was reduced under fluoroscopic control and compressed. Restoration of the pre- pseudoarthrosis anatomic axis of the humerous did not permit perfect anatomical reduction of the new fracture. The post-operative course was uneventful, and there were no vascular or neurological complications. Two days after surgery the patient was able to move the shoulder and the arm. Seven days after surgery, she was dismissed from the hospital with a prescription for physical therapy, instructions for riches medication. Clinical and radiographic follow-up monitoried the evolution of callus formation for the fracture and healing of the pseudoarthrosis. The external fixator was removed five months after surgery: the patient bad excellent shoulder and elbow joint mobility and normal muscle strenght. In this case, the external fixator enable not only optimum consolidation of the recent fracture but also healing of the old pseudoarthrosis without the riskes of a directly invasive procedure.