Open Reduction with Internal Fixation

Open reduction techniques for humeral nonunion are well described, with reported union rates ranging from 80 to 96 (3-6,11). Jupiter specifically described treatment of atrophic nonunion in obese patients with a medial approach, anterior plate, and vascularized fibular graft. All four nonunions that were treated healed, but not without complication (9). Radial nerve palsy remains a potential risk and is reported to occur in 3 to 29 of nonunion cases (14). The principles of successful treatment...

Coonrad Morrey Semiconstrained Total Elbow Replacement Operative Technique

Coonrad Morrey Elbow

Arthroplasty of the elbow represents a solution to the nonunion of the distal humeral fracture in a select group of patients (42). In the elderly, previous unsuccessful treatment may well have led to disuse osteopenia, complicating the preexisting osteoporosis that contributed to the original injury. Often the fracture fragments may be comminuted and very distal. In such circumstances, revision of previously attempted internal fixation is unlikely to yield satisfactory results, even if eventual...

Nonunions Of The Elbow

Fractures about the elbow are relatively uncommon, and problems of nonunion can largely be avoided by optimum primary treatment. However, nonunions do occur and, in the case of fractures of the distal humerus, have an incidence of approximately 3 to 5 (25). They are twice as common in females, especially Figure 4 Infected nonunion of the forearm following open reduction internal fixation. C and D. AP and lateral views at presentation, showing hardware failure and 1-year nonunion. E. Initial...

Nonoperative Management

Treatment Fractured Humerus

The biomechanics of the humerus and its surrounding tissues make it readily reducible. The free movement of the scapulohumeral joint minimizes torsional stresses through the bone, making rigid immobilization unnecessary for proper healing (3). In addition, the humerus acts mostly as a lever, with little or no weight-bearing function or compressive forces. The influence of gravity places the fracture fragments in a physiologically dependent position, which facilitates reduction (3). Many...

Classification

Ulnar Intraneural Topography

Nerve injuries are classified according to the Sunderland classification 4 . In grade I injuries neuropraxias , the nerve sustains a focal demyelination affecting axonal transport but the structural integrity of the individual axons and nerve remains intact. Walllerian degeneration does not occur, there is no Tinel's sign, and complete recovery is expected within weeks to months. In grade II injuries axono-tomesis , the axon is disrupted but the endoneurium remains intact. Wallarian...