Corrective Osteotomy for Intra-Articular Distal Humerus Malunion

Document Type: RESEARCH PAPER

Authors

1 Department of Orthopaedic Surgery, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

2 Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey 2100, 55 Fruit Street, Boston, MA 02114, USA

Abstract

 
 
 
 Background: An intra-articular distal humerus malunion can be disabling. To improve function, reduce pain and/ or prevent further secondary osteoarthritis an intra-articular corrective osteotomy can be considered. Herein we present the indications, practical guidelines for pre- operative planning and surgical technique. Subsequently, we provide long-term results in a small series.
 
Methods: We included six consecutive patients operated for intra-articular distal humerus malunion. Mean follow-up was 88 months. At lastest follow up elbow function was assessed according to standardized questionnaires and classification systems.
 
Results: All six patients healed their osteotomies. Three patients had a postoperative complication which were treated succesfully. Range of motion improved significantly and all patients were satisfied with the outcome. The elbow performance scores were good to excellent in all. Correlation analyses showed that age and level of osteoarthritis are very strong predictors for the long-term elbow function and quality of life.
 
Conclusion: An intra-articular corrective osteotomy for a malunited distal humerus fracture is a worthwhile procedure. Based on our results it should particularly be considered in young patients with minimal osteoarthritis and moderate to severe functional disability and/or pain.
 

Keywords


  1. Jupiter JB. The management of nonunion and malunion of the distal humerus-a 30-year experience. J Orthop Trauma. 2008; 22(10):742-50.
  2. Nauth A, McKee MD, Ristevski B, Hall J, Schemitsch EH. Distal humeral fractures in adults. J Bone Joint Surg Am. 2011; 93(7):686-700.
  3. Obert L, Ferrier M, Jacquot A, Mansat P, Sirveaux F, Clavert P, et al. Distal humerus fractures in patients over 65: Complications. Orthop Traumatol Surg Res. 2013; 99(8):909-13.
    1. Skaggs DL, Glassman D, Weiss JM, Kay RM. A new surgical technique for the treatment of supracondylar humerus fracture malunions in children. J Child Orthop. 2011; 5(4):305-12.
    2. McKee M, Jupiter J, Toh CL, Wilson L, Colton C, Karras KK. Reconstruction after malunion and nonunion of intra-articular fractures of the distal humerus. Methods and results in 13 adults. J Bone Joint Surg Br. 1994; 76(4):614-21.
    3. Kazuki K, Miyamoto T, Ohzono K. Intra-articular corrective osteotomy for the malunited intercondylar humeral fracture: a case report. Osaka City Med J. 2002; 48(1):95-100.
    4. Marti R, Doornberg J. Intra-articular osteotomy for distal humerus malunion. Case Rep Med. 2009; 2009(10):1-4.
    5. Marti R, van Heerwaarden R. Osteotomies for posttraumatic deformities. Stuttgart, Germany: Thieme; 2008. P. 131-5.
    6. Cohen MS, Jupiter JB. Intra-articular osteotomy formalunited articular fractures of the distal end of thehumerus. J Shoulder Elbow Surg. 2014; 23(4):579-85.
    7. McKee MD, Jupiter JB, Bamberger HB. Coronal shear fractures of the distal end of the humerus. J Bone Joint Surg Am. 1996; 78(1):49-54.
    8. Pollock JW, Athwal GS, Steinmann SP. Surgical exposures for distal humerus fractures: a review. Clin Anat. 2008; 21(8):757-68.
    9. Helfet DL, Kloen P, Anand N, Rosen HS. ORIF of delayed unions and nonunions of distal humeral fractures. Surgical technique. J Bone Joint Surg Am. 2004; 86(1):18-29.
    10. King GJ, Richards RR, Zuckerman JD, Blasier R, Dillman C, Friedman RJ, et al. A standardized method for assessment of elbow function. Research Committee, American Shoulder and Elbow Surgeons. J Shoulder Elbow Surg. 1999; 8(4):351-4.
    11. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996; 29(6):602-8.
    12. Morrey BF, Adams RA. Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow. J Bone Joint Surg Am. 1992; 74(4):479-90.
    13. Broberg MA, Morrey BF. Results of delayed excision of the radial head after fracture. J Bone Joint Surg Am. 1986; 68(5):669-74.
    14. Cobb TK, Linscheid RL. Late correction of malunited intercondylar humeral fractures. Intra-articular osteotomy and tricortical bone grafting. J Bone Joint Surg Br. 1994; 76(4):622-6.
    15. Nowak TE, Dietz SO, Burkhart KJ, Muller LP, Rommens PM. [Fractures of the elbow joint]. 2012; 83(2):181-97.