J Korean Fract Soc.  2012 Oct;25(4):310-316. 10.12671/jkfs.2012.25.4.310.

Treatment of Non-union Distal Humerus Fractures after Operation

• Kim HS
• Jang KJ
• Choi YR
• Koh IH
• Kang HJ

• KMID: 1434072
• DOI: http://doi.org/10.12671/jkfs.2012.25.4.310

Abstract

PURPOSE
This study is a retrospective analysis of patients who had undergone surgical treatment for non-union of distal humerus fracture. We evaluated them in terms of causes of injury, radiologic findings, and clinical outcomes such as prognosis.
MATERIALS AND METHODS
Seven consecutive radiologic patients who were confirmed to have nonunion of a distal humerus fracture underwent reoperations. These patients had already undergone operations for distal humerus fractures. This survey was held from 2005 to 2010. The average period up to diagnosis of non-union after the first operation was 7.4 months (4 to 16 months). The mean follow-up period was 24.6 months (12 to 65 months). Each patient was graded functionally according to the Mayo Elbow Performance Score and the Disabilities of the Arm, Shoulder and Hand Score.
RESULTS
Osteosynthesis was performed by internal fixation with plates and screws and then a bone graft for non-union of the distal humerus fracture. The average range of motion within the elbow joints was found to be a flexion contracture of 18.8 degrees (0~30 degrees) and further flexion of 120.2 degrees (102~140 degrees). Among postoperative complications, three cases of medium-degree stiffness, two cases of medial column nonunion, and one case of dissociation of the internal fixator were reported.
CONCLUSION
Stable internal fixation for maintenance reduction status is essential after accurate initial anatomical reduction. We concluded that nonunion could be prevented by additional surgical treatment such as autogenous bone graft, if it is necessary.

Keyword

Distal humerus fracture; Nonunion; Surgical treatment

MeSH Terms

Arm
Contracture
Dissociative Disorders
Elbow
Elbow Joint
Follow-Up Studies
Hand
Humans
Humerus
Internal Fixators
Postoperative Complications
Range of Motion, Articular
Retrospective Studies
Shoulder
Transplants

Figure

• 

  Fig. 1 (A) A 70-year-old woman who had a closed AO type-C2 fracture. (B) The patient was treated with internal fixation with two plates and screws and allogenous bone graft. (C) Follow-up at 6 months after an initial treatment by open reduction and internal fixation using two Acumed® plates with allo bone graft. The anteroposterior and lateral radiographs reveal a nonunion of the medial condyle with a slight callus (arrows). (D) Radiographs made 10 months after treatment of the non-union by internal fixation with additional double Acumed® plates and autologous iliac bone-grafting. The anteroposterior and flexion-extension radiographs show good healing and the functional results were good.

• 

  Fig. 2 (A) A 69-year-old woman sustained a closed AO type C3 fracture. (B) The patient was treated with open reduction and internal fixation with plates and allogenous bone-grafting. (C) Follow-up at 6 months after initial treatment. The anteroposterior and lateral radiographs showing the nonunion of the medial condyle and breakage of the plate (arrows). (D) The patient was treated with total elbow arthroplasty.

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