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?



Massachusetts General Hospital, Department of Orthopaedics, Boston, MA, USA


Background: The purpose of this retrospective study was to analyze the long-term results of revision ORIF, joint
contracture release, and autogenous bone-grafting in the treatment of distal humerus frac-ture nonunions in older aged
patients 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 fracture
nonunion treated with revision ORIF, joint contracture release and autogenous bone grafting between 1989-2000 were
available for follow-up. Radiographic union and arthrosis were assessed using the most recent radiograph. Pain-related
outcomes were measured using PROMIS Pain Interference scores. Functional outcomes were evaluated using the
Mayo Elbow Perfor-mance Index (MEPI).
Results: After an average follow-up of 22 years (range: 19-27 years), all nonunions were healed after the index
procedure 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 exertional
discomfort but none required chronic pain medica-tions. PROMIS-Pain Interference scores were no different than the
general population (mean [95%CI] = 49.2 [41.8, 56.6], P=0.83). Per the MEPI, the functional result was excellent in five
patients, good in one, and poor in one.
Conclusion: Despite older age and worse bone quality, distal humerus fracture nonunions can be treated using revision
ORIF, joint contracture release and autogenous bone-grafting with acceptable long-term outcomes.
Level of evidence: IV


Main Subjects