Open Reduction and Internal Fixation Using Double Plating with Biological and Artificial Bone Grafting of Aseptic Non-unions of the Distal Humerus: Clinical Results

Abstract

A bstract Aim Intra-articular non-union of fractures is an uncommon but complex problem because in general, it is characterised by marked instability, pain, strength loss and significant functional limitation. The aim of this study is to report our prospective medium-term outcomes of the treatment of intra-articular, distal humeral aseptic non-unions using open reduction and internal fixation, augmented with artificial bone. Materials and methods A retrospective case series of 16 patients with intra-articular, aseptic non-unions of the distal humerus was analysed for range of motion, pain, Mayo Elbow Performance Scores (MEPS) and Oxford Elbow Scores (OES) after 12 months. Mean age was 44 years (range, 18–84 years) and mean total follow-up was 43 months (range, 24–62 months). Results All subjective and objective scores were significantly higher 12 months after treatment with internal fixation and artificial bone augmentation; the mean improvement on the MEPS was 18 points and 17 points on the OES. All patients returned to work, most without limitations. Autografts had worse outcomes compared to allografts regarding post-operative pain and time to return to work. No adverse events related to the artificial bone augmentation were seen and all fractures consolidated. Conclusion The use of two locking plates and bone graft augmentation with autografts or allografts with artificial bone grafts is a successful treatment of intra-articular distal humeral non-unions after hardware failure or biological limitations. Clinical significance The use of artificial bone in the treatment of septic non-unions of the upper limb is safe. When no autograft is possible because of concurrent morbidity, it can be used alone or combined with an allograft to reconstruct the affected bone without leading to extra morbidity or complications. How to cite this article Rollo G, Vicenti G, Rotini R, et al. Open Reduction and Internal Fixation Using Double Plating with Biological and Artificial Bone Grafting of Aseptic Non-unions of the Distal Humerus: Clinical Results. Strategies Trauma Limb Reconstr 2021;16(3):144–151.

Massive bone defects due to infection at the surgical site associated with a distal humeral fracture that was treated using fibula autograft: a case report

“…The results of a retrospective case series study aimed at evaluating the success of open reduction and internal fixation using double plating with biological and artificial bone grafting on 16 patients with aseptic nonunions of the distal humerus showed that after hardware failure or biological constraints, the use of two locking plates and bone graft augmentation using autografts or allografts with artificial bone grafts is an effective treatment for intra-articular distal humeral nonunions 19 . Another study investigated the plate-and-bone-strut-allograft method with bone chip augmentation in third humeral shaft aseptic nonunions.…”

Distal and/or Proximal Joint Stiffness Among Post-Fracture Patients Treated in University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia

“…Current evidence on the assessment of outcomes in proximal or distal joint stiffness in intra-articular non-union fractures, treated with open reduction and internal fixation augmented with artificial bone, shows good outcomes in terms of muscle strength, rate of return to work, and function, as assessed by the Mayo Elbow Performance Score and Oxford Elbow Score. 28 , 29 In addition, studies have reported that surgical treatment can restore the structural stability of the joint and soft-tissue structure in an injury with dislocation or subluxation. 29–32 …”

“…28 , 29 In addition, studies have reported that surgical treatment can restore the structural stability of the joint and soft-tissue structure in an injury with dislocation or subluxation. 29–32 …”