Abhiram R Bhashyam1,2, Jesse B Jupiter1,2. 1. Massachusetts General Hospital, Department of Orthopaedics, Boston, MA, USA. 2. Research performed at Massachusetts General Hospital, Boston, MA, USA.
Abstract
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.
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.
Authors: Matthias Klum; Maya B Wolf; Peter Hahn; Franck M Leclère; Thomas Bruckner; Frank Unglaub Journal: Arch Orthop Trauma Surg Date: 2012-09-16 Impact factor: 3.067