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Simple and Complex Fractures of the Humerus pp 313–326Cite as

The Malunion and Nonunion of Distal Humerus Fractures

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Abstract

Nonunion and malunion are two of the most common complications after distal humerus fractures. The risk of malunion or nonunion following fractures is influenced by a variety of factors: biology, in particular the blood supply of the metaphysis; the nonanatomic reduction of the fracture; and the methods of osteosynthesis and mechanical failure.

This chapter reviews the anatomic aspects of the distal humerus malunion and nonunion, their surgical options, and the outcomes observed and their prevention and treatment as shown in the following summary: introduction, the extra-articular distal humerus malunion (varus malunion, extension malunion), the intra-articular distal humerus malunion (surgical techniques for preserved joint congruency and less than 50 % of articular damage, surgical techniques for lost joint congruency and over than 50 % of articular damage), outcomes of malunion, the distal humerus nonunion (internal fixation, joint replacement), outcomes of nonunion, and prevention and treatment of malunion and nonunion.

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References

  1. Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37(8):691–697

    Article  PubMed  Google Scholar 

  2. Kashiwagi D (1975) Outerbridge Kashiwagi arthroplasty for osteoarthritis of the elbow, the elbow joint. Kashiwagi D (ed) Elsevier Science publishers (Biomedical Division), Amsterdam, pp 177–188

    Google Scholar 

  3. Muller LP, Hansen M, Morrey BF, Prommersberger KJ, Rommens PM (2008) The surgery of neglected distal humerus fractures in children and adult. In Celli A, Celli L, Morrey BF (eds), treatment of elbow lesion. Springer, New York, pp 221–230

    Google Scholar 

  4. McKee M, Jupiter J, Toh CL, Wilson L, Colton C, Karras KK (1994) Reconstruction after malunion and nonunion of intra-articular fractures of the distal humerus. Methods and results in 13 adults. J Bone Joint Surg Br 76(4):614–621

    PubMed  CAS  Google Scholar 

  5. Cobb TK, Linscheid RL (1994) Late correction of malunited intercondylar humeral fractures. Intra-articular osteotomy and tricortical bone grafting. J Bone Joint Surg Br 76(4):622–626

    PubMed  CAS  Google Scholar 

  6. Davids JR, Maguire MF, Mubarak SJ, Wenger DR (1994) Lateral condylar fracture of the humerus following posttraumatic cubitus varus. J Pediatr Orthop 14(4):466–470

    Article  PubMed  CAS  Google Scholar 

  7. Tricot M, Duy KT, Docquier PL (2012) 3D-corrective osteotomy using surgical guides for posttraumatic distal humeral deformity. Acta Orthop Belg 78(4):538–542

    PubMed  Google Scholar 

  8. Skaggs DL, Glassman D, Weiss JM, Kay RM (2011) A new surgical technique for the treatment of supracondylar humerus fracture malunions in children. J Child Orthop 5(4):305–312

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lim TK, Koh KH, Lee do K, Park MJ (2011) Corrective osteotomy for cubitus varus in middle-aged patients. J Shoulder Elbow Surg 20(6):866–872

    Article  PubMed  Google Scholar 

  10. Hahn SB, Choi YR, Kang HJ (2009) Corrective dome osteotomy for cubitus varus and valgus in adults. J Shoulder Elbow Surg 18(1):38–43

    Article  PubMed  Google Scholar 

  11. Gong HS, Chung MS, Oh JH, Cho HE, Baek GH (2008) Oblique closing wedge osteotomy and lateral plating for cubitus varus in adults. Clin Orthop Relat Res 466(4):899–906

    Article  PubMed  PubMed Central  Google Scholar 

  12. Husband JB, Hastings H (1990) The lateral approach for operative release of post-traumatic contracture of the elbow. J Bone Joint Surg Am 72(9):1353–1358

    PubMed  CAS  Google Scholar 

  13. Mansat P, Morrey BF (1998) The column procedure: a limited lateral approach for extrinsic contracture of the elbow. J Bone Joint Surg Am 80(11):1603–1615

    PubMed  CAS  Google Scholar 

  14. Stans AA, Maritz NG, O’Driscoll SW, Morrey BF (2002) Operative treatment of elbow contracture in patients twenty-one years of age or younger. J Bone Joint Surg Am 84-A(3):382–387

    PubMed  Google Scholar 

  15. Cohen AP, Redden JF, Stanley D (2000) Treatment of osteoarthritis of the elbow: a comparison of open and arthroscopic debridement. Arthroscopy 16(7):701–706

    Article  PubMed  CAS  Google Scholar 

  16. Kim SJ, Shin SJ (2000) Arthroscopic treatment for limitation of motion of the elbow. Clin Orthop Relat Res 375:140–148

    Article  PubMed  Google Scholar 

  17. Cefo I, Eygendaal D (2011) Arthroscopic arthrolysis for posttraumatic elbow stiffness. J Shoulder Elbow Surg 20(3):434–439

    Article  PubMed  Google Scholar 

  18. Charalambous CP, Morrey BF (2012) Posttraumatic elbow stiffness. J Bone Joint Surg Am 94(15):1428–1437

    Article  PubMed  Google Scholar 

  19. Cheng SL, Morrey BF (2000) Treatment of the mobile, painful arthritic elbow by distraction interposition arthroplasty. J Bone Joint Surg Br 82(2):233–238

    Article  PubMed  CAS  Google Scholar 

  20. Celli A, Morrey BF (2009) Total elbow arthroplasty in patients forty years of age or less. J Bone Joint Surg Am 91(6):1414–1418

    Article  PubMed  Google Scholar 

  21. McKee MD, Wilson TL, Winston L, Schemitsch EH, Richards RR (2000) Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach. J Bone Joint Surg Am 82-A(12):1701–1707

    PubMed  CAS  Google Scholar 

  22. Pajarinen J, Björkenheim JM (2002) Operative treatment of type C: intercondylar fractures of the distal humerus: results after a mean follow-up of 2 years in a series of 18 patients. J Shoulder Elbow Surg 11(1):48–52

    Article  PubMed  Google Scholar 

  23. Sanders RA, Raney EM, Pipkin S (1992) Operative treatment of bicondylar intraarticular fractures of the distal humerus. Orthopedics 15(2):159–163

    PubMed  CAS  Google Scholar 

  24. Soon JL, Chan BK, Low CO (2004) Surgical fixation of intra-articular fractures of the distal humerus in adults. Injury 35(1):44–54

    Article  PubMed  CAS  Google Scholar 

  25. Korner J, Lill H, Müller LP, Hessmann M, Kopf K, Goldhahn J, Gonschorek O, Josten C, Rommens PM (2005) Distal humerus fractures in elderly patients: results after open reduction and internal fixation. Osteoporos Int 16(Suppl 2):S73–S79

    Article  PubMed  Google Scholar 

  26. Yamaguchi K, Sweet FA, Bindra R, Morrey BF, Gelberman RH (1997) The extraosseous and intraosseous arterial anatomy of the adult elbow. J Bone Joint Surg Am 79:1654

    Google Scholar 

  27. Jupiter JB, Goodman LJ (1992) The management of complex distal humerus nonunion in the elderly by elbow capsulectomy, triple plating, and ulnar nerve neurolysis. J Shoulder Elbow Surg 1(1):37–46

    Article  PubMed  CAS  Google Scholar 

  28. Mitsunaga MM, Bryan RS, Linscheid RL (1982) Condylar nonunions of the elbow. J Trauma 22(9):787–791

    Article  PubMed  CAS  Google Scholar 

  29. Ackerman G, Jupiter JB (1988) Non-union of fractures of the distal end of the humerus. J Bone Joint Surg Am 70(1):75–83

    PubMed  CAS  Google Scholar 

  30. Helfet DL, Kloen P, Anand N, Rosen HS (2003) Open reduction and internal fixation of delayed unions and nonunions of fractures of the distal part of the humerus. J Bone Joint Surg Am 85-A(1):33–40

    PubMed  Google Scholar 

  31. Ring D, Gulotta L, Jupiter JB (2003) Unstable nonunions of the distal part of the humerus. J Bone Joint Surg Am 85-A(6):1040–1046

    PubMed  Google Scholar 

  32. Ali A, Douglas H, Stanley D (2005) Revision surgery for nonunion after early failure of fixation of fractures of the distal humerus. J Bone Joint Surg Br 87(8):1107–1110

    Article  PubMed  CAS  Google Scholar 

  33. Morrey BF, Adams RA (1995) Semiconstrained elbow replacement for distal humeral nonunion. J Bone Joint Surg Br 77(1):67–72

    PubMed  CAS  Google Scholar 

  34. Cil A, Veillette CJ, Sanchez-Sotelo J, Morrey BF (2008) Linked elbow replacement: a salvage procedure for distal humeral nonunion. J Bone Joint Surg Am 90(9):1939–1950

    Article  PubMed  Google Scholar 

  35. Sanchez-Sotelo J, Morrey BF (2009) Linked elbow replacement: a salvage procedure for distal humeral nonunion. Surgical technique. J Bone Joint Surg Am 91(Suppl 2):200–212

    PubMed  Google Scholar 

  36. LaPorte DM, Murphy MS, Moore JR (2008) Distal humerus nonunion after failed internal fixation: reconstruction with total elbow arthroplasty. Am J Orthop 37(10):531–534

    PubMed  Google Scholar 

  37. Espiga X, Antuña SA, Ferreres A (2011) Linked total elbow arthroplasty as treatment of distal humerus nonunions in patients older than 70 years. Acta Orthop Belg 77(3):304–310

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Shoulder and Elbow Unit, Hesperia Hospital, Via Emilia Est 380/1, Modena, 41124, Italy

    Andrea Celli

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  1. Andrea Celli
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Correspondence to Andrea Celli .

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Editors and Affiliations

  1. Department of Orthopaedics and Traumatology, CTO Hospital Turin, Turin, Italy

    Filippo Castoldi

  2. Department of Orthopaedics and Traumatology, Mauriziano-Umberto I Hospital, Turin, Italy

    Davide Blonna

  3. Department of Orthopaedics and Traumatology, Mauriziano-Umberto I Hospital, Turin, Italy

    Marco Assom

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Celli, A. (2015). The Malunion and Nonunion of Distal Humerus Fractures. In: Castoldi, F., Blonna, D., Assom, M. (eds) Simple and Complex Fractures of the Humerus. Springer, Milano. https://doi.org/10.1007/978-88-470-5307-6_28

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  • DOI: https://doi.org/10.1007/978-88-470-5307-6_28

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  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-5306-9

  • Online ISBN: 978-88-470-5307-6

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