Surgical Technique: Treatment of Distal Humerus Nonunions

Abstract

BackgroundOpen reduction and internal fixation of distal humerus fractures is standard of care with good to excellent outcome for most patients. However, nonunions of the distal humerus still occur. These are severely disabling problems for the patient and a challenge for the treating physician. Fortunately, a combination of standard nonunion techniques with new plate designs and fixation methods allow even the most challenging distal humeral nonunion to be treated successfully.Questions/PurposesThe purpose of this manuscript is to describe our current technique in treating distal humeral nonunion as it has evolved over the last four decades. We have now follow-up on 62 treated patients.MethodsA few key steps are essential to obtain bone healing while regaining or preserving elbow motion. These include careful planning, extensile exposure, release of the ulnar nerve, capsular release and mobilization of the distal fragment, debridement, and finally stable fixation after alignment with application of bone graft.ResultsThe vast majority of distal humeral nonunions can be treated successfully with open reduction and internal fixation.ConclusionImportant components of the treatment plan are careful preoperative planning, extensile approach, debridement, and solid fixation with—locking—plates and liberal use of bone graft.Electronic supplementary materialThe online version of this article (doi:10.1007/s11420-017-9551-y) contains supplementary material, which is available to authorized users.

Distal humerus kaynamamaları

“…[11] Kaynamayan humerus distal uçta; açık redüksiyon internal tespit ve gerekirse greftleme [2,3,13] , protez replasmanı [17] , allogreft ile dirsek replasmanı [18] , dirsek artrodezi [11] , distraksiyon artroplastisi [19] , Ilizarov tekniği ile osteosentez [20] tedavileri uygulanabilir. Kondil [9] ve epikondil kaynamamasında ise açık redüksiyon internal tespit ve gerekirse greftleme yapılabilir.…”

“…Ciddi kemik kaybı veya yumuşak dokusu kötü olan olgulara geçici eksternal fiksatör uygulanabilir. [5,13,20] …”

“…Bu değerlerde yükselme, enfeksiyon ihtimalini akla getirmelidir. [5,13] Humerusta kaynamayan alan ve dirsek ekleminden aspirasyon gerekirse, ultrasonografi veya BT altında yapılmalıdır. İdeal olarak, hastalar antibiyotik kullanmayı aspirasyondan 2 ila 4 hafta önce kesmelidir.…”

“…[16] Distal humerus kaynamaması önemli oranda eklem parçalarının anatomiye yakın iyileştiği suprakondiller seviyededir. [7,13] Şekil 5. Distal humerus kaynamaması için Mitsunaga sınıflaması: (A) suprakondiller, (B) T-kondiller, (C) lateral kondiller, (D) transkondiller ve (E) mediyal kondiller.…”

Treatment of supracondylar humeral non-union by bone autograft and Hoffmann II external fixation

“…To the best of our knowledge, the use of Hoffmann II external fixation to treat supracondylar humeral non-unions has not previously been reported in the English medical literature. Treatment with Ilizarov method (circular external fixation), with or without humerus shortening, appears in a few studies, with good results, but the implant is very bulky which is a source of discomfort to the patient [3,[7][8][9].…”