Distal humerus nonunion after failed internal fixation: reconstruction with total elbow arthroplasty

Area of Science:

• Orthopedic Surgery
• Reconstructive Surgery

Background:

• Distal humerus fractures can lead to nonunion, complicated by osteoporosis, devascularized fragments, and fibrosis.
• Limited reconstructive options exist for long-standing, painful distal humerus nonunions previously treated with rigid internal fixation.

Purpose of the Study:

• To assess pain relief, functional gains, and complications of semiconstrained total elbow arthroplasty in patients with nonunion after distal humerus fracture.
• To evaluate the efficacy of a triceps-sparing approach and anterior ulnar nerve transposition in these reconstructions.

Main Methods:

• Retrospective assessment of 12 patients with long-standing distal humerus nonunion.
• Reconstruction using semiconstrained total elbow arthroplasty, often with a triceps-sparing approach and anterior ulnar nerve transposition.
• Evaluation of pain, function (range of motion), and complications at a mean follow-up of 63 months.

Main Results:

• 11 out of 12 patients achieved good pain relief and good or excellent functional results.
• Mean flexion/extension improved to 134° to 18°, with a mean total arc of motion of 117°.
• Mean pronation/supination was 74° to 69°, despite a 75% complication rate (8 patients).

Conclusions:

• Semiconstrained total elbow arthroplasty is a viable treatment option for recalcitrant distal humerus nonunions.
• The procedure can yield significant pain relief and functional restoration in challenging cases.
• While complications are common, the benefits often outweigh the risks for this difficult patient population.