Surgical Technique: Treatment of Distal Humerus Nonunions

BACKGROUND: Open reduction and internal fixation of distal humerus fractures is standard of care with good to excellent outcome for most patients. However, nonunions of the distal humerus still occur. These are severely disabling problems for the patient and a challenge for the treating physician. Fortunately, a combination of standard nonunion techniques with new plate designs and fixation methods allow even the most challenging distal humeral nonunion to be treated successfully. QUESTIONS/PURPOSES: The purpose of this manuscript is to describe our current technique in treating distal humeral nonunion as it has evolved over the last four decades. We have now follow-up on 62 treated patients. METHODS: A few key steps are essential to obtain bone healing while regaining or preserving elbow motion. These include careful planning, extensile exposure, release of the ulnar nerve, capsular release and mobilization of the distal fragment, debridement, and finally stable fixation after alignment with application of bone graft. RESULTS: The vast majority of distal humeral nonunions can be treated successfully with open reduction and internal fixation. CONCLUSION: Important components of the treatment plan are careful preoperative planning, extensile approach, debridement, and solid fixation with—locking—plates and liberal use of bone graft. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11420-017-9551-y) contains supplementary material, which is available to authorized users.