What is meaning of non union of distal end of humerus as well as ulna?
Answers
Answered by
0
Distal humerus non-union is one of the most feared complications in elbow trauma; although it can be painless and may not require treatment, in general it is characterised by marked instability, pain, strength loss and significant functional limitation [7, 17, 20]. Complex fractures, poor bone quality, soft tissue lesions and bad patient selection, particularly if associated with incorrect or inadequate internal fixation, favour complications. The reported incidence of non-union after the treatment of distal humerus fractures ranges between 2 and 10% [7, 21]. The complexity of the treatment of these lesions is usually increased by its association with poor bone quality, small bony fragments difficult to stabilise and to previous operations and approaches compromising soft tissues and the olecranon. Treatment options in distal humerus non-unions include open reduction and internal fixation with plates and screws, intramedullary nails, external fixator, total elbow replacement, interposition arthroplasty, resection arthroplasty, replacement using allograft and elbow arthrodesis. Internal fixation with plates and screws is the treatment of choice in active patients [1, 5, 7, 8, 11, 12, 17, 19, 22]. If surgery is indicated, it must restore function in a long-lasting way; for this it is necessary to achieve bony union, with no pain, and to restore an acceptable range of motion (ROM).
The objective of this paper is to evaluate the long-term functional results achieved after open reduction and internal fixation (ORIF) of 24 distal humerus non-unions, treated in an 11-year period with an average follow-up of 46 months.
Material and methods
Twenty-four patients with non-union at the distal end of the humerus, who underwent ORIF between 1995 and 2006, were retrospectively evaluated. Sixteen patients were male and eight female; their age averaged 45 years (range: 19–73). All fractures were secondary to trauma: 13 patients had high-energy trauma and 11 had low-energy trauma. Reconstruction was indicated only in patients whose distal humerus articular surface was preserved or reconstructible. Non-unions treated with joint replacement, interposition arthroplasty and arthrodesis were excluded. Seven fractures had originally been open; classification of initial fracture type and of the severity of soft tissue lesions was not possible since 21 patients were referred from another institution after failure in the treatment of the original fracture. Of the 24 patients, 23 had had previous operations (range: 1–5); 11 fractures were approached through an olecranon osteotomy. Two patients had had two previous olecranon osteotomies and two presented with an olecranon non-union. Initial stabilisation was performed using: two plates in four cases, one plate in five cases, only screws in six cases, Rush nails in two cases, an intramedullary nail in two cases, an external fixator in two cases and multiple Kirschner wires and screws in two cases. Five patients presented preoperative ulnar nerve neuropraxia and two had radial nerve neuropraxia. The time between original trauma or surgery and revision surgery averaged 14 months (range: 4–46). Non-union was defined as failure in radiographic progression of callus formation six months after initial trauma or surgery and/or implant loosening or breakage at least four months after the original surgery.
The objective of this paper is to evaluate the long-term functional results achieved after open reduction and internal fixation (ORIF) of 24 distal humerus non-unions, treated in an 11-year period with an average follow-up of 46 months.
Material and methods
Twenty-four patients with non-union at the distal end of the humerus, who underwent ORIF between 1995 and 2006, were retrospectively evaluated. Sixteen patients were male and eight female; their age averaged 45 years (range: 19–73). All fractures were secondary to trauma: 13 patients had high-energy trauma and 11 had low-energy trauma. Reconstruction was indicated only in patients whose distal humerus articular surface was preserved or reconstructible. Non-unions treated with joint replacement, interposition arthroplasty and arthrodesis were excluded. Seven fractures had originally been open; classification of initial fracture type and of the severity of soft tissue lesions was not possible since 21 patients were referred from another institution after failure in the treatment of the original fracture. Of the 24 patients, 23 had had previous operations (range: 1–5); 11 fractures were approached through an olecranon osteotomy. Two patients had had two previous olecranon osteotomies and two presented with an olecranon non-union. Initial stabilisation was performed using: two plates in four cases, one plate in five cases, only screws in six cases, Rush nails in two cases, an intramedullary nail in two cases, an external fixator in two cases and multiple Kirschner wires and screws in two cases. Five patients presented preoperative ulnar nerve neuropraxia and two had radial nerve neuropraxia. The time between original trauma or surgery and revision surgery averaged 14 months (range: 4–46). Non-union was defined as failure in radiographic progression of callus formation six months after initial trauma or surgery and/or implant loosening or breakage at least four months after the original surgery.
Similar questions