gms | German Medical Science

Objectives/Interrogation: Assessment of the effectiveness of surgical treatment of nonunions of the distal humerus.

Methods: The analysis of surgical treatment of 66 patients (43 men, 23 women) with the consequences of treatment of fractures and nonunions of the distal humerus was performed. The average age of patients consisted 47.2 ± 14.9 years. All patients have undergone surgery previously, but due to various reasons, consolidation of the distal humerus was not achieved. Patients were hospitalized in 6.2 ± 4.1 months after injury. During clinical investigation all of them had pathological mobility at the level of nonunion, movements in the elbow joint were significantly limited.

Results: In 18 cases the skin defect of the elbow region was substituted by vascularized skin flap. Treatment was started from osteosynthesis of the distal humerus with autogenous iliac bone grafting. After surgery - early rehabilitation was performed with changeable daily splinting in flexion and extension. After bone consolidation (approximately in 1 year or more after osteosynthesis) removal of fixators was performed with the simultaneous mobilization of the elbow joint. After the operation, an early rehabilitation treatment was also carried out using cast in full extension at night and at 90 degrees of flexion for a day time.

We evaluated results of surgical treatment with MEPS scale in 7-12 monthes after surgery. Good results were obtained at 79,4% of cases and satisfactory in 21,6% of patients. The outcome of the treatment depended on the severity of the primary injury, the time passed from the moment of injury and level of patient motivation.

Conclusions: Complex of reconstructive interventions (skin defects substitution, osteosynthesis and bone grafting, joint mobilization) in combination with early rehabilitation, allowed to obtain good results of treatment in 79.4% of cases in patients with the consequences of severe injuries of distal humerus.