Bone transport combined with internal fixation in post-traumatic distal humerus defects and nonunions: retrospective...

This analysis aimed to assess the functional outcomes of patients with post-traumatic distal humerus defects and nonunions treated by bone transportation combined with internal fixation, containing two surgical techniques designed to enhance docking site union and functional recovery in critical distal humerus defects.

This retrospective study included 16 patients with post-traumatic distal humerus defects who underwent bone transportation combined with internal fixation between June 2017 and December 2023. Clinical records and consecutive X-ray images were reviewed to assess bone regeneration and alignment. The ASAMI criteria were applied to assess the bone and functional recovery, whereas the functional outcomes of the elbow joint were evaluated applying the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Postoperative complications were classified using the Paley classification. Radial nerve function was systematically monitored preoperatively and at follow-up visits through comprehensive motor and sensory examination, with particular emphasis on delayed radial nerve palsy. Overall patient recovery, including range of motion (ROM) and functional improvement, was correlated with the DASH scores and postoperative complications. Statistical significance was defined as P < 0.05.

The study included 16 patients ( mean age of 36.1 ± 8 years) with a mean humeral defect size of 5.6 ± 1.1 cm. The mean follow-up time was 22.1 ± 1.9 months, the average external fixation time (EFT) was 9.1 ± 1.4 months and the external fixation index (EFI) was 1.65 ± 0.11 months/cm. All humeral defects were successfully reconstructed. According to the ASAMI criteria, the treatment outcome was excellent in 6 cases, good in 8, and fair in 2. Elbow function significantly improved (p<0.01) post-operatively according to the DASH score. Mild extensional dysfunction was reported in 2 cases, and no radial nerve injuries or recurrent infections were observed. Pin tract infections were observed in 9 (56.26%) patients but were effectively managed with standardized dressing changes, without compromising the overall prognosis. The remaining patients achieved satisfactory clinical and functional recovery.

Bone transport combined with internal plate fixation effectively addresses post-traumatic distal humerus defects and nonunions by shortening external fixation time and lowering the incidence of docking site nonunion. This approach also eliminates the need for iliac bone grafting, thereby minimizing secondary trauma and enabling satisfactory joint function recovery.