revision fixation of distal humerus fracture nonunions in older age patients with poor bone quality or bone loss – is this viable as a long-term treatment option?

Background: the purpose of this retrospective study was to analyze the long-term results of revision orif, jointcontracture release, and autogenous bone-grafting in the treatment of distal humerus frac-ture nonunions in older agedpatients 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 fracturenonunion treated with revision orif, joint contracture release and autogenous bone grafting between 1989-2000 wereavailable for follow-up. radiographic union and arthrosis were assessed using the most recent radiograph. pain-relatedoutcomes were measured using promis pain interference scores. functional outcomes were evaluated using themayo elbow perfor-mance index (mepi). results: after an average follow-up of 22 years (range: 19-27 years), all nonunions were healed after the indexprocedure 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 exertionaldiscomfort but none required chronic pain medica-tions. promis-pain interference scores were no different than thegeneral population (mean [95%ci] = 49.2 [41.8, 56.6], p=0.83). per the mepi, the functional result was excellent in fivepatients, good in one, and poor in one.conclusion: despite older age and worse bone quality, distal humerus fracture nonunions can be treated using revisionorif, joint contracture release and autogenous bone-grafting with acceptable long-term outcomes.