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The Journal of Bone and Joint Surgery (American) 85:33-40 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Open Reduction and Internal Fixation of Delayed Unions and Nonunions of Fractures of the Distal Part of the Humerus

David L. Helfet, MD, Peter Kloen, MD, PhD, Neel Anand, MD and Howard S. Rosen, MD

Investigation performed at the Hospital for Special Surgery and the Hospital for Joint Diseases, New York, NY

David L. Helfet, MD
Peter Kloen, MD, PhD
Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for D.L. Helfet: helfetd{at}hss.edu E-mail address for P. Kloen: kloenp@hss.edu

Neel Anand, MD
Institute for Spinal Disorders, Cedars Sinai Medical Center, 444 South San Vicente Boulevard, Suite 800, Los Angeles, CA 90048. E-mail address: anandn@cshs.org

Howard S. Rosen, MD (deceased)

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: The purpose of the present retrospective study was to evaluate the results of open reduction and internal fixation of delayed unions and nonunions of fractures of the distal part of the humerus.

Methods: Between 1976 and 2001, fifty-two patients with a delayed union (thirteen patients) or nonunion (thirty-nine patients) of the distal part of the humerus were treated with open reduction and internal fixation along with selective elbow joint arthrolysis and bone-grafting. The average time to presentation was eighteen months (range, two to 192 months) after the injury. Thirty-nine of the fifty-two patients had undergone an average of 1.6 previous operations. There were twenty-seven supracondylar, six transcondylar, thirteen intercondylar, two lateral condylar, and four medial condylar delayed unions or nonunions. The average duration of follow-up was thirty-three months (range, three to 198 months).

Results: Fifty-one of the fifty-two patients had healing of the delayed union or nonunion after the index operation; the average time to union was six months (range, two to twenty-four months). The average range of elbow motion increased from 71° preoperatively to 94° postoperatively. Complications included two superficial infections, two deep infections, and five cases of ulnar neuropathy. Fifteen patients (29%) needed additional surgery after the index procedure. Specifically, seven patients underwent removal of prominent hardware; six underwent hardware removal along with excision of heterotopic bone, ulnar neurolysis, and/or manipulation under anesthesia; one underwent irrigation and débridement; and one underwent compartment release.

Conclusions: Open reduction through an extensile exposure and rigid internal fixation consistently results in healing of a delayed union or nonunion of the distal part of the humerus. An improved range of motion of the elbow can be achieved by securing the site of the nonunion and performing aggressive elbow joint arthrolysis and soft-tissue releases in patients with severe contractures.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See p. 2 for complete description of levels of evidence.


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Letters to the Editor:

Read all Letters to the Editor

Distal humeral nonunions-is osteoporosis important to guide the nature of fixation
Vikas Yadav
JBJS Online, 26 Jun 2003 [Full text]
Re: Distal humeral nonunions-is osteoporosis important to guide the nature of fixation
David L. Helfet
JBJS Online, 17 Jul 2003 [Full text]