Article
Distal Humerus Nonunion After Failed Internal Fixation: Reconstruction With Total Elbow Arthroplasty
Am J Orthop. 2008 October;37(10):531-534
Author and Disclosure Information
Dawn M. LaPorte, MD, Michael S. Murphy, MD, and J. Russell Moore, MD
Dr. LaPorte is Assistant Professor, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.
Dr. Murphy is Assistant Professor, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, and Faculty, Curtis National Hand Center and The Greater Chesapeake Hand Specialists, Lutherville, Maryland.
Dr. Moore is Faculty, Curtis National Hand Center and The Greater Chesapeake Hand Specialists, Lutherville, Maryland.
In nonunion after distal humerus fracture, osteoporosis, devascularized fracture fragments, and periarticular fibrosis limit potential reconstructive options. We assessed pain relief, functional gains, and complications in 12 patients whose long-standing, painful nonunions after previous treatment with rigid internal fixation were reconstructed with a semiconstrained total elbow arthroplasty, frequently with a triceps-sparing approach and anterior ulnar nerve transposition. At mean follow-up of 63 months, 11 patients had good pain relief and a good or excellent functional result: mean flexion/extension, 134° to 18°; mean total arc of motion, 117°; mean pronation/supination, 74° to 69°. Despite the 75% rate of complications (8), semiconstrained total elbow arthroplasty provides a viable treatment for this difficult problem.