Treatment of Non-union Distal Humerus Fractures after Operation

Hyung-Sik Kim; Ki-Joon Jang; Yun-Rak Choi; Il-Hyun Koh; Ho-Jung Kang

doi:10.12671/jkfs.2012.25.4.310

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Kim, Jang, Choi, Koh, and Kang: Treatment of Non-union Distal Humerus Fractures after Operation

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2012; 25(4): 310-316.

Published online: 19 October 2012

DOI: https://doi.org/10.12671/jkfs.2012.25.4.310

Treatment of Non-union Distal Humerus Fractures after Operation

Hyung-Sik Kim, M.D., Ki-Joon Jang, M.D., Yun-Rak Choi, M.D., Il-Hyun Koh, M.D., Ho-Jung Kang, M.D.

Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Address reprint requests to: Ho-Jung Kang, M.D. Department of Orthopedic Surgery, Gangnam Severance Hospital, 146-92, Dogok-dong, Gangnam-gu, Seoul 120-749, Korea. Tel: 82-2-2019-3410, Fax: 82-2-573-5393, kijoon2@hanmail.net

Received 21 July 2012 Revised 8 September 2012 Accepted 11 September 2012

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.

Keywords: Distal humerus fracture, Nonunion, Surgical treatment

Figures and Tables

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.

Table 1

Data on 7 Patients with Nonunion of the Distal Humerus

BMD: Bone mineral density, F: Female, OR/IF: Open reduction and internal fixation, AIBG: Autologous iliac bone graf, Fx.: Fracture, DRUJ: Distal radioulnar joint, F/U: Follow-up, Dx: Diagnosis.

Table 2

Post-operative Evaluation

ROM: Range of motion, pre op.: Pre-operative, post op.: Post-operative, F/U: Follow-up, MEPS: Mayo Elbow Performance Score, DASH: The Disability of Arm, Shoulder and Hand Score.

Table 3

Causes of Non-union

BG: Bone graft.

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