Revision Fixation of Distal Humerus Fracture Nonunions in Older Age Patients with Poor Bone Quality or Bone Loss – Is This Viable as a Long-term Treatment Option

Background: The purpose of this retrospective study was to analyze the long-term results of revision ORIF, jointcontracture release, and autogenous bone-grafting in the treatment of distal humerus frac-ture nonunions in older agedpatients with poor bone quality or bone loss who would have been candidates for total elbow arthroplasty.Methods: Seven patients (average age at index procedure: 53.3 years, range: 41-75) with a distal humerus fracturenonunion treated with revision ORIF, joint contracture release and autogenous bone grafting between 1989-2000 wereavailable for follow-up. Radiographic union and arthrosis were assessed using the most recent radiograph. Pain-relatedoutcomes were measured using PROMIS Pain Interference scores. Functional outcomes were evaluated using theMayo Elbow Perfor-mance Index (MEPI).Results: After an average follow-up of 22 years (range: 19-27 years), all nonunions were healed after the indexprocedure and had an average arc of ulnohumeral motion of 80°, flexion of 112°, and flex-ion contracture of 32°.Average arthrosis grade was moderate joint-space narrowing with osteo-phyte formation. One patient had exertionaldiscomfort but none required chronic pain medica-tions. PROMIS-Pain Interference scores were no different than thegeneral population (mean [95%CI] = 49.2 [41.8, 56.6], P=0.83). Per the MEPI, the functional result was excellent in fivepatients, good in one, and poor in one.Conclusion: Despite older age and worse bone quality, distal humerus fracture nonunions can be treated using revisionORIF, joint contracture release and autogenous bone-grafting with acceptable long-term outcomes.Level of evidence: IV

Keywords:

Humeral fractures , Osteoporotic fractures , Ununited Fracture