High-velocity gunshot-related humeral fractures managed with circular external fixation in a resource-limited setting, Samburu County, Kenya: Surgical technique highlights from a case series.

Introduction: High-velocity gunshot-related humeral fractures are complex injuries often associated with a high rate of nonunion, infection, and poor functional outcome. In low- and middle-income countries these injuries are further complicated by delayed presentation and implant unavailability. Staged management with spanning external fixation followed by internal fixation with intramedullary nail or plate has been well described in the literature; however, the use of a circular frame as a definitive treatment has been very seldom mentioned. Materials and Methods: Six high-velocity gunshot-related humeral fractures cases were treated with a single stack half ring circular external fixator as a definitive surgery performed by a single surgeon. Aspects related to surgical technique, fracture reduction, infection prevention, and restoration of upper limb function using circular frame external fixator are described. Results: Fracture union was achieved with circular fixation alone in 5 of the 6 patients. One patient developed a nonunion and required a second operation with a lateral compression plate combined with iliac crest autograft. The median circular fixator time was 16 weeks, and the median elbow range of motion was from 0° to 130° of flexion. The median shoulder range of motion was from 0° to 170° of overhead extension. The median Quick-DASH score was 4.5. No patients developed pin site infections. Conclusion: Single-stage definitive treatment with a circular external fixator may be a valid option, not only for surgeons working in resource-constrained environments, for high-velocity gunshot fractures of the humerus. Patients' cultural acceptance and maintenance of the external device far exceeded our expectations.