The purpose of the present retrospective study was to evaluate the results
of open reduction and internal fixation of delayed unions and nonunions of
fractures of the distal part of the humerus.
Between 1976 and 2001, fifty-two patients with a delayed union (thirteen
patients) or nonunion (thirty-nine patients) of the distal part of the humerus
were treated with open reduction and internal fixation along with selective
elbow joint arthrolysis and bone-grafting. The average time to presentation
was eighteen months (range, two to 192 months) after the injury. Thirty-nine
of the fifty-two patients had undergone an average of 1.6 previous operations.
There were twenty-seven supracondylar, six transcondylar, thirteen
intercondylar, two lateral condylar, and four medial condylar delayed unions
or nonunions. The average duration of follow-up was thirty-three months
(range, three to 198 months).
Fifty-one of the fifty-two patients had healing of the delayed union or
nonunion after the index operation; the average time to union was six months
(range, two to twenty-four months). The average range of elbow motion
increased from 71° preoperatively to 94° postoperatively.
Complications included two superficial infections, two deep infections, and
five cases of ulnar neuropathy. Fifteen patients (29%) needed additional
surgery after the index procedure. Specifically, seven patients underwent
removal of prominent hardware; six underwent hardware removal along with
excision of heterotopic bone, ulnar neurolysis, and/or manipulation under
anesthesia; one underwent irrigation and débridement; and one underwent
Open reduction through an extensile exposure and rigid internal fixation
consistently results in healing of a delayed union or nonunion of the distal
part of the humerus. An improved range of motion of the elbow can be achieved
by securing the site of the nonunion and performing aggressive elbow joint
arthrolysis and soft-tissue releases in patients with severe contractures.