title: Distal humerus nonunion after failed internal fixation: reconstruction with total elbow arthroplasty.
abstract: 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 degrees to 18 degrees; mean total arc of motion, 117 degrees ; mean pronation/supination, 74 degrees to 69 degrees. Despite the 75% rate of complications (8), semiconstrained total elbow arthroplasty provides a viable treatment for this difficult problem.
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD 21224-2780, USA. ehenze1@jhmi.edu
authors.forename: Dawn M
authors.initials: DM
authors.lastname: LaPorte
authors.forename: Michael S
authors.initials: MS
authors.lastname: Murphy
authors.forename: J Russell
authors.initials: JR
authors.lastname: Moore
mesh_terms: D000328:Adult; D000368:Aged; D001178:Arthroplasty; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D017211:Treatment Failure