gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Long term outcome of open reduction and internal fixation of distal humeral nonunions in the older age patient

Meeting Abstract

Search Medline for

  • presenting/speaker Jesse Jupiter - Massachusetts General Hospital, Harvard Medical School, Boston, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-300

doi: 10.3205/19ifssh0092, urn:nbn:de:0183-19ifssh00921

Published: February 6, 2020

© 2020 Jupiter.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives/Interrogation: While arthroplasty offers an alternative in the treatment of complex nonunions of the distal humerus in the older age patient, its longevity remains a concern. In contrast, restoration of the articular anatomy with a successful ORIF may offer a more predictable outcome.

In order to explore this hypothesis, we elected to obtain long term follow-up in a cohort of patients 48 years and older at the time of their operative treatment to gain union.

Methods: Out of a total of 95 patient seen and treated for a distal humeral nonunion by a single surgeon, 23 patients 48 years and over at the time of their index procedure to gain union (range 48 to 67 years). Seventeen were female and 6 male with the dominant limb involved in 15. Five patients were found to have deceased and at the time of writing, 6 were still unable to be located leaving twelve patient available for follow up at an average of l8 years (range 13-24 years).

Four nonunions were at the supracondylar level; 7 were combined intra and extraarticular nonunions; and one primarily involved the articular surface of the lateral column. All but two had major capsular contracture with 7 substantial ulnar nerve dysfunction requiring neurolysis and transposition.

Internal fixation required 3 contoured plates in 10 patients with 4 plates and 2 plates in one each. Autogenous iliac crest bone graft was used in 9 patients with a vascularized fibular graft in one to bridge a bony defect.

Results and Conclusions: At an average follow up of 18 years (range 13-24 years), all but one remained united after the index procedure with the one converted to a total elbow arthroplasty after one year. One other patient required a repeat capsular release. The average age at follow up was 76 years (range 61-99 years). Examination revealed an average elbow flexion of 115 degrees with average flexion contracture of 36 degrees. The average Quickdash was 26 and average PROMIS 39.5. The average Mayo elbow score was 84 (range 55-95). The follow up radiographs demonstrated in the majority of patients evidence of mild to moderate arthrosis.

While some residual functional deficits exist with some radiographic changes over time, the results of this group of patients would suggest that a successful ORIF of a distal humeral nonunion including those involving the articular surface will remain durable and offer the patient a functional outcome.