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The Journal of Bone and Joint Surgery (American) 84:593-598 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Long-Standing Nonunion of Fractures of the Lateral Humeral Condyle

Satoshi Toh, MD, Kenji Tsubo, MD, Shinji Nishikawa, MD, Sadahiro Inoue, MD, Ryuujiro Nakamura, MD and Seiko Harata, MD

Investigation performed at the Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Aomori, Japan

Satoshi Toh, MD
Seiko Harata, MD
Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Zaifu-cho-5, Hirosaki, Aomori 036-8562, Japan. E-mail address for S. Toh: toh{at}cc.hirosaki-u.ac.jp

Kenji Tsubo, MD
Department of Orthopaedic Surgery, Aomori City Hospital, Katsuta-cho-1-14-20, Aomori, Aomori 030-0821, Japan

Shinji Nishikawa, MD
Department of Orthopaedic Surgery, Mutsu General Hospital, Ogawa-cho-1-2-5, Mutsu, Aomori 035-0071, Japan

Sadahiro Inoue, MD
Department of Orthopaedic Surgery, Misawa City Hospital, Chuo-cho 4-1-10, Misawa, Aomori 033-0001, Japan

Ryuujiro Nakamura, MD
Nakamura Orthopaedic Clinic, Nagayama 7-jo, 16-102-7, Asahikawa, Hokkaido 079-8417, Japan

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Patients with nonunion of a fracture of the lateral humeral condyle often have pain, instability, or progressive cubitus valgus deformity with tardy ulnar nerve palsy. However, some patients have minimal or no symptoms or disabilities. We evaluated patients with long-standing established nonunion of the lateral humeral condyle to correlate the clinical long-term outcome of this condition with the original fracture type.

Methods: Nineteen elbows in eighteen patients who were at least twenty years of age were evaluated. Fourteen patients were male, and four were female. The average age at presentation was 42.5 years. The average interval from the injury to the presentation of the symptoms of the nonunion was thirty-seven years. Patients were divided into two groups on the basis of the size of the fragment and the location of the fracture line. Group 1 included nine elbows with nonunion resulting from a Milch Type-I injury, and Group 2 included ten elbows with a nonunion resulting from a Milch Type-II injury. Evaluations were performed with use of radiographic examination, clinical assessment, and calculation of the Broberg and Morrey score.

Results: Symptoms were seen more frequently in Group 1 than in Group 2. The range of flexion in Group 1 (range, 60° to 145°; average, 99°) was more restricted than that in Group 2 (range, 100° to 150°; average, 129°) (p = 0.0078). The functional score in Group 2 was significantly higher than that in Group 1 (p = 0.03).

Conclusion: Disabling symptoms only rarely developed in Group-2 patients. Occasionally, however, these patients do present with clinically detectable dysfunction of the ulnar nerve. In contrast, pain, instability, and loss of range of motion as well as ulnar nerve dysfunction developed in Group 1. For this reason we think that a nonunion of a Milch Type-I fracture should be treated as soon as possible after injury, preferably before the patient reaches skeletal maturity.


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