Ilizarov Method for Treatment of Extraarticular Distal Humerus Fractures TODD GUYETTE, M.D. Curtis National Hand Center Union Memorial Hospital Baltimore, Maryland, U.S.A. ARKADY BLYAKHER, M.D. Hospital for Special Surgery New York, New York, U.S.A. S. ROBERT ROZBRUCH, M.D. Institute for Limb Lengthening and Reconstruction Hospital for Special Surgery Weill Medical College of Cornell University New York, New York, U.S.A. S ummary: The Ilizarov method for fracture manage- ment has historically been reserved for complex de- formities, recalcitrant nonunions, and high-grade open fractures. Advances in the understanding of fracture healing and the importance of the soft tissue envelope have led to the use of external fixation for routine frac- ture management. Application of the Ilizarov method provides stable fixation by allowing early range of mo- tion while minimizing soft tissue trauma and preserving the fracture fragment blood supply. The authors present a technique and illustrative case describing the use of the Ilizarov method for acute extraarticular distal humerus fracture management.  HISTORICAL PERSPECTIVE External fixation for fracture management has been used for nearly 150 years. In 1853, Malgaigne first described the use of the external fixator, utilizing a claw hook for patellar fracture fixation (1). Subsequently, the external fixator has evolved from its simple uniplanar beginnings to more complex multiplanar fixation devices as de- scribed by Ilizarov in 1951(2). As the physiology of frac- ture healing has become better understood, the role of external fixation in the trauma setting has begun to ex- pand. The common perception for the indications of the Ilizarov technique, such as complex scenarios with re- calcitrant nonunions, complex deformities, shortening, and high-grade open fractures, has now been extended to include routine fracture management. External fixation for fracture management offers the advantages of percu- taneous fracture reduction with minimal soft tissue trauma and preservation of blood supply to the fracture fragments. Although fractures of the distal humerus account for only 2% of all adult fractures, they contribute a signifi- cantly higher morbidity than other articular or periarticu- lar fractures (3). Historically, the fracture has been asso- ciated with significant pain, loss of range of motion, instability, and neuropathies, all of which have adversely affected outcome (3–7). It has become clear that ana- tomic reduction of the joint surface alone is insufficient for a satisfactory outcome. Anatomic reduction must be accompanied by early postoperative range of motion therapy to provide the best opportunity for a functional recovery. Advanced techniques utilizing internal fixation have improved the clinical outcomes for patients with distal humerus fractures by achieving this anatomic re- duction while allowing early mobilization (5–8). Volkov et al. (9) published one of the first reports in the English language orthopedic literature of external fixation of the distal humerus, which they accomplished by utilizing the fixator for stabilization and distraction across the joint surface in elbow fracture nonunions and contractures. Subsequently in the literature there have been reported case series in which the frame has been used for malunions, nonunions, osteotomies, and Address correspondence and reprint requests to Dr. Robert Rozbruch, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, U.S.A. E-mail: rozbruchsr@hss.edu Techniques in Shoulder & Elbow Surgery 3(4):299–305, 2002 © 2002 Lippincott Williams & Wilkins, Inc., Philadelphia  TECHNIQUE  299 Volume 3, Issue 4