Advertisement

International Orthopaedics

, Volume 33, Issue 5, pp 1289–1294 | Cite as

Post-traumatic distal humerus non-union

Open reduction and internal fixation: long-term results
  • Christian AllendeEmail author
  • Bartolomé T. Allende
Original Paper

Abstract

The objective of this paper is to evaluate the long-term functional results achieved after open reduction and internal fixation of 24 distal humerus non-unions. Non-unions were extra-articular-extracapsular (11 cases), extra-articular-intracapsular (8 cases) and intra-articular (5 cases). Preoperative elbow range of motion averaged 45°. Time between original trauma and revision surgery averaged 14 months. Stabilisation methods varied according to type and location of the non-union. Follow-up averaged 46 months (range: 18–108). Elbow range of motion at last examination averaged 98°. Flexion averaged 110° and extension loss averaged 17°. The disabilities of the arm, shoulder and hand (DASH) score averaged 16 points. Secondary transposition of the ulnar nerve was necessary in three cases. Sixteen patients reported no pain at last examination, seven had mild pain and one had moderate pain. Distal humerus non-unions present different characteristics; consequently, surgical treatment must be individualised for each patient. Even though they are demanding procedures, bony union and good long-term functional results were achieved.

Keywords

Ulnar Nerve Tension Band Distal Humerus Poor Bone Quality Olecranon Osteotomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

L’objectif de cette étude est d’évaluer à long terme les résultats fonctionnels obtenus après réduction sanglante et fixation interne de 24 pseudarthroses de l’extrémité distale de l’humérus. Matériel et méthode: la pseudarthrose était extra articulaire et extra capsulaire dans 11 cas, extra articulaire et intra capsulaire dans 8 cas et intra articulaire dans 5 cas. La mobilité pre opératoire du coude était en moyenne de 45° et le temps entre le trauma initial et la réintervention de 14 mois. Les méthodes de fixation ont été différentes selon la localisation de la pseudarthrose. Résultats: après 46 mois de suivi en moyenne (de 18 à 108), la mobilité du coude au dernier examen était de 98° en moyenne, la flexion autour de 110° et le défaut d’extension de 17°. Le score DASH a été de 16 points en moyenne. La transposition secondaire du nerf cubital a été nécessaire dans trois cas. 16 patients se plaignaient de douleur au dernier examen, 7 avec une très légère douleur et 1 avec douleur modérée. En conclusion, les pseudarthroses de l’extrémité distale de l’humérus présentent différentes caractéristiques, notamment sur le plan chirurgical, celles-ci devant être individualisées pour chaque patient. Cependant, il s’agit d’une technique très demandeuse qui permet de bons résultats à long terme.

References

  1. 1.
    Ackerman G, Jupiter JB (1988) Non-union of fractures of the distal end of the humerus. J Bone Joint Surg Am 70:75–83PubMedGoogle Scholar
  2. 2.
    Ali A, Douglas H, Stanley D (2005) Revision surgery for nonunion after early failure of fixation of fractures of the distal humerus. J Bone Joint Surg Br 87:1107–1110PubMedCrossRefGoogle Scholar
  3. 3.
    Breen T, Gelberman RH, Leffert R, Botte M (1988) Massive allograft replacement of hemiarticular traumatic defects of the elbow. J Hand Surg [Am] 13:900–907 Erratum in: J Hand Surg [Am] 1989;14:582CrossRefGoogle Scholar
  4. 4.
    Figgie MP, Inglis AE, Mow CS, Figgie HE 3rd (1989) Salvage of non-union of supracondylar fracture of the humerus by total elbow arthroplasty. J Bone Joint Surg Am 71:1058–1065PubMedGoogle Scholar
  5. 5.
    Gallay SH, McKee MD (2000) Operative treatment of nonunions about the elbow. Clin Orthop 370:87–101PubMedCrossRefGoogle Scholar
  6. 6.
    Haidukewych GJ, Sperling JW (2003) Results of treatment of infected humeral nonunions: the Mayo Clinic experience. Clin Orthop Relat Res 414:25–30PubMedCrossRefGoogle Scholar
  7. 7.
    Helfet DL, Kloen P, Anand N, Rosen HS (2003) Open reduction and internal fixation of delayed unions and nonunions of fractures of the distal part of the humerus. J Bone Joint Surg Am 85-A:33–40PubMedGoogle Scholar
  8. 8.
    Jupiter JB, Goodman IJ (1992) The management of complex distal humerus nonunion in the elderly by elbow capsulectomy, triple plating, and ulnar nerve neurolysis. J Shoulder Elbow Surg 1:37–46CrossRefGoogle Scholar
  9. 9.
    Korner J, Lill H, Muller LP, Rommens PM, Schneider E, Linke B (2003) The LCP-concept in the operative treatment of distal humerus fractures—biological, biomechanical and surgical aspects. Injury 34(Suppl 2):B20–B30PubMedCrossRefGoogle Scholar
  10. 10.
    Llinas A, McKellop HA, Marshall GJ, Sharpe F, Kirchen M, Sarmiento A (1993) Healing and remodeling of articular incongruities in a rabbit fracture model. J Bone Joint Surg Am 75:1508–1523PubMedGoogle Scholar
  11. 11.
    McKee M, Jupiter J, Toh CL, Wilson L, Colton C, Karras KK (1994) Reconstruction after malunion and nonunion of intra-articular fractures of the distal humerus. Methods and results in 13 adults. J Bone Joint Surg Br 76:614–621PubMedGoogle Scholar
  12. 12.
    Mitsunaga MM, Bryan RS, Linscheid RL (1982) Condylar nonunions of the elbow. J Trauma 22:787–791PubMedCrossRefGoogle Scholar
  13. 13.
    Morrey BF, Adams RA (1995) Semiconstrained elbow replacement for distal humerus nonunion. J Bone Joint Surg Br 77:67–72PubMedGoogle Scholar
  14. 14.
    Mullett H, Hausman M, Zaidemberg C (2008) Recalcitrant distal humeral and proximal forearm nonunion: salvage using an extended pedicled radial forearm osseous flap. J Trauma 64:E60–E64PubMedCrossRefGoogle Scholar
  15. 15.
    Pelissier P, Masquelet AC, Bareille R, Pelissier SM, Amedee J (2004) Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res 22:73–79PubMedCrossRefGoogle Scholar
  16. 16.
    Ramsey ML, Adams RA, Morrey BF (1999) Instability of the elbow treated with semiconstrained total elbow arthroplasty. J Bone Joint Surg Am 81:38–47PubMedGoogle Scholar
  17. 17.
    Ring D, Gulotta L, Jupiter JB (2003) Unstable nonunions of the distal part of the humerus. J Bone Joint Surg Am 85-A:1040–1046PubMedGoogle Scholar
  18. 18.
    Salter RB, Simmonds DF, Malcolm BW et al (1980) The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit. J Bone Joint Surg Am 62:1232–1251PubMedGoogle Scholar
  19. 19.
    Sanders RA, Sackett JR (1990) Open reduction and internal fixation of delayed union and nonunion of the distal humerus. J Orthop Trauma 4:254–259PubMedCrossRefGoogle Scholar
  20. 20.
    Schatzker J (1990) Intraarticular malunions and nonunions. Orthop Clin North Am 21:743–757PubMedGoogle Scholar
  21. 21.
    Sim FH, Morrey BF (2000) Non-union and delayed union of distal humeral fractures. In: Morrey BF (ed) The elbow and its disorders, 3rd edn. Saunders, Philadelphia, pp 331–340Google Scholar
  22. 22.
    Simonis RB, Nuñez VA, Khaleel A (2003) Use of the Coventry infant hip screw in the treatment of nonunion of fractures of the distal humerus. J Bone Joint Surg Br 85:74–77PubMedCrossRefGoogle Scholar
  23. 23.
    Trumble T, Allan CH, Miyano J, Clark JM, Ott S, Jones DE, Fernacola P, Magnusson M, Tencer A (2001) A preliminary study of joint surface changes after an intraarticular fracture: a sheep model of a tibia fracture with weight bearing after internal fixation. J Orthop Trauma 15:326–332PubMedCrossRefGoogle Scholar
  24. 24.
    Trumble T, Verheyden J (2004) Remodeling of articular defects in an animal model. Clin Orthop Relat Res 423:59–63PubMedCrossRefGoogle Scholar
  25. 25.
    Urbaniak JR, Aitken M (1987) Clinical use of bone allografts in the elbow. Orthop Clin North Am 18:311–321PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Division of Upper Extremity and Reconstructive SurgerySanatorio Allende - Hospital Nacional de ClínicasCordobaArgentina

Personalised recommendations