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. 2009 Oct;33(5):1289-94.
doi: 10.1007/s00264-008-0650-8. Epub 2008 Aug 28.

Post-traumatic distal humerus non-union : Open reduction and internal fixation: long-term results

Christian Allende  1 , Bartolomé T Allende
Affiliations

Post-traumatic distal humerus non-union : Open reduction and internal fixation: long-term results

Christian Allende et al. Int Orthop. 2009 Oct.

Abstract
in English, French

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 degrees. 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 degrees . Flexion averaged 110 degrees and extension loss averaged 17 degrees . 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.

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.

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Figures

Fig. 1
Fig. 1
a Anteroposterior preoperative X-ray showing a distal humerus non-union with insufficient osteosynthesis using three screws. b Union after stabilisation with two posterior reconstruction plates. The distal screw of the medial plate goes through the medial column
Fig. 2
Fig. 2
a, b Anteroposterior and lateral X-rays: distal humerus extra-articular-intracapsular non-union, previous stabilisation with two Rush nails. c Anteroposterior X-ray showing union 9 years after surgery, olecranon V-type osteotomy approach and stabilisation with two dorsal plates
See this image and copyright information in PMC

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