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?

Abstract

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