Session V - Post Traumatic Reconstruction

*Ununited Fractures of the Distal Humerus: Plate Fixation and Autogenous Bone Graft

David Ring, MD; Larry Gulotta, MD; Jesse B. Jupiter, MD, Massachusetts General Hospital, Boston, MA (all authors ­ a-AO Foundation)

Purpose: Distal humerus nonunion can be treated with total elbow arthroplasty or internal fixation and autogenous bone graft. Total elbow arthroplasty is best reserved for older, low-demand patients. We reviewed the results of internal fixation.

Methods: Forty patients were treated with ulnar nerve transposition and neurolysis, elbow contracture release, plate and screw fixation, and autogenous bone graft. Twenty-one patients were women and 19 were men, with an average age of 49 years (range, 18 to 74 years).

Results: Four nonunions failed to heal: two were treated with total elbow arthroplasty, one healed after reoperation, and one patient declined further intervention. A second surgical procedure was required in 20 additional patients: 18 had contracture release and 2 had ulnar nerve release. At a mean follow-up of 54 months, the average arc of ulnohumeral motion of patients who retained their native elbow was 101° (range 65° to 130°). Thirty-four of 37 patients who retained their native elbow had a good or excellent functional result according to the rating of Broberg and Morrey.

Conclusions: Operative fixation of ununited fractures of the distal humerus restores a healed, functional elbow in most cases, but often requires a secondary surgical procedure for elbow contracture release or ulnar neuropathy even when these factors were addressed at the initial operation.