Fig. 5.1
Anteroposterior (a) and lateral (b) radiographs of a supracondylar humerus nonunion. Loss of fixation and alignment of the fracture fragments can be seen, as well as a gap at the previous fracture site
The nonunion (Fig. 5.2) was first assessed for the presence of infection and then treated with removal of the implants, debridement of the nonunion site, revision ORIF with 90–90 specialty plates. An olecranon osteotomy was performed to maximize exposure of the distal fragment and to aid in the mobilization of the elbow joint. The nonunion site was also augmented with demineralized bone matrix and allograft cancellous bone chips and the nonunion went onto heal uneventfully.
Fig. 5.2
Anteroposterior (a) and lateral (b) radiographs of the nonunion site, which has been reduced and stabilized with a medial and lateral plate and bone grafted with an iliac crest bone graft assisted by an olecranon osteotomy
Case 2
A 53-year-old male fell at home sustaining a closed supracondylar intercondylar humeral fracture. He was originally treated with a closed reduction and splinting of the elbow and was subsequently treated with ORIF with an olecranon osteotomy. Early motion was begun at approximately 10 days postoperatively, and his incision healed uneventfully. Although his pain decreased during the first several weeks, at six weeks post-op, he felt a snap in the elbow and experienced increased pain and swelling of the elbow (Figs. 5.3, 5.4, 5.5 and 5.6).
Fig. 5.3
Anteroposterior (a) and lateral (b) radiographs demonstrating a displaced supracondylar intercondylar humerus fracture
Fig. 5.4
Anteroposterior (a) and lateral (b) radiographs following open reduction and internal fixation of the displaced supracondylar intercondylar humerus fracture shown in Fig. 5.3
Fig. 5.5
Anteroposterior (a), oblique (b), and lateral (c) radiographs show failure of medial plate, an indication that a nonunion is developing
Fig. 5.6
Anteroposterior (a), oblique (b), and lateral (c) radiographs after removal of medial implants, reduction of the medial condyle, and revision open reduction and internal fixation with an iliac crest bone graft
References
1.
Ring D, Gullotta L, Jupiter JB. Unstable nonunions of the distal part of the humerus. J Bone Joint Surg Am. 2003;85-A(6):1040–5.
2.
Jupiter JB. The management of nonunion and malunion of distal humerus—30 year experience. J Ortho Trauma. 2008;22(10):742–50.Crossref
3.
4.
Brinker MA, O’Connor DP, Monla YT. Metabolic and endocrine abnormalities in patients with nonunions. J Ortho Trauma. 2007;21(8):557–70.Crossref
5.
Stucken C, Olszewski DC, Creevy WR, Murakami AM, Tornetta P. Preoperative diagnosis of infection in patients with nonunions. J Bone Joint Surg Am. 2013;95(15):1409–12.
