Distal humerus nonunion: evaluation and management

Despite recent improvements in surgical implants and techniques, distal humerus nonunion does occur between 8% and 25% of the time. Careful identification and improvement of any modifiable risk factors such as smoking, metabolic disorders, immunosuppressant medications, poor nutritional status and i...

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Bibliographic Details
Published in:EFORT Open Reviews 2020-05, Vol.5 (5), p.289-298
Main Authors: Vauclair, Frédéric, Goetti, Patrick, Nguyen, Ngoc Tram V., Sanchez-Sotelo, Joaquin
Format: Article
Language:English
Subjects:
Arthroplasty
Bone grafts
Bone healing
Bone loss
Cartilage
Cartilage (articular)
Cartilage diseases
Computed tomography
Diagnosis
Distal Humerus
Elbow
Humerus
Infection
Internal Fixation
Metabolic disorders
Nonunion
Nutritional status
Osteoarthritis
Risk factors
Shoulder & Elbow
Treatment
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Summary:Despite recent improvements in surgical implants and techniques, distal humerus nonunion does occur between 8% and 25% of the time. Careful identification and improvement of any modifiable risk factors such as smoking, metabolic disorders, immunosuppressant medications, poor nutritional status and infection is mandatory. A recent computed tomography scan is paramount to determine the nonunion pattern, assess residual bone stock, identify previously placed hardware, and determine whether there is evidence of osteoarthritis or malunion of the articular surface. Internal fixation is the treatment of choice in the majority of patients presenting with reasonable bone stock and preserved articular cartilage; total elbow arthroplasty is an appealing alternative for elbows with severe destruction of the articular cartilage or severe bone loss at the articular segment, especially in older, female patients. Internal fixation requires not only achieving a stable fixation, but also releasing associated elbow contractures and the liberal use of bone graft or substitutes. Although reported union rates after internal fixation of distal humerus nonunions are excellent (over 95%), the complication rate remains very high, and unsatisfactory results do occur. Cite this article: EFORT Open Rev 2020;5:289-298. DOI: 10.1302/2058-5241.5.190050
ISSN:2396-7544
2058-5241
2058-5241
DOI:10.1302/2058-5241.5.190050