Junichi Miyake1, Kozo Shimada, Takashi Masatomi. 1. Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. miyake-osk@umin.ac.jp
Abstract
HYPOTHESIS: Osteosynthesis for longstanding nonunion of the lateral humeral condyle in adults has a high rate of complications, including failure of bony union and restriction of elbow motion. We hypothesized that rigid fixation may contribute to higher union rate and the placement of the condyle fragment with proper tilting may minimize the reduction of elbow motion. MATERIALS AND METHODS: Ten patients were treated with osteosynthesis. Average age at operation was 38.6 years. Three patients had dysfunction of the ulnar nerve, 2 experienced pain, and 5 had both presentations. According to Toh et al's radiographic criteria, nonunion was categorized as Group 1 in 2 patients and Group 2 in 8 (J Bone Joint Surg Am 2002;84:593-598). We performed osteosynthesis with iliac bone graft and ulnar nerve anterior transposition, with efforts to fix the fragment rigidly and to manage the fragment position properly. RESULTS: Osseous union was achieved in all 8 Group 2 patients, while 1 Group 1 case showed delayed union and the other did not achieve union. Pain resolved and ulnar nerve symptoms improved in all cases. In 9 patients with union, total arc of motion was reduced by an average of 20°. The preoperative mobility of the condyle fragment determined by maximum flexion and extension lateral radiographs had a correlation to the postoperative loss of motion (P = .047); however, loss of motion was less than that expected by radiographs. CONCLUSION: Osteosynthesis appears to be indicated for Group 2 nonunion with pain. Rigid fixation with care of the position of the fragment is important for the good outcomes.
HYPOTHESIS: Osteosynthesis for longstanding nonunion of the lateral humeral condyle in adults has a high rate of complications, including failure of bony union and restriction of elbow motion. We hypothesized that rigid fixation may contribute to higher union rate and the placement of the condyle fragment with proper tilting may minimize the reduction of elbow motion. MATERIALS AND METHODS: Ten patients were treated with osteosynthesis. Average age at operation was 38.6 years. Three patients had dysfunction of the ulnar nerve, 2 experienced pain, and 5 had both presentations. According to Toh et al's radiographic criteria, nonunion was categorized as Group 1 in 2 patients and Group 2 in 8 (J Bone Joint Surg Am 2002;84:593-598). We performed osteosynthesis with iliac bone graft and ulnar nerve anterior transposition, with efforts to fix the fragment rigidly and to manage the fragment position properly. RESULTS: Osseous union was achieved in all 8 Group 2 patients, while 1 Group 1 case showed delayed union and the other did not achieve union. Pain resolved and ulnar nerve symptoms improved in all cases. In 9 patients with union, total arc of motion was reduced by an average of 20°. The preoperative mobility of the condyle fragment determined by maximum flexion and extension lateral radiographs had a correlation to the postoperative loss of motion (P = .047); however, loss of motion was less than that expected by radiographs. CONCLUSION: Osteosynthesis appears to be indicated for Group 2 nonunion with pain. Rigid fixation with care of the position of the fragment is important for the good outcomes.