RECONSTRUCTION AFTER MALUNION AND NONUNION OF INTRAARTICULAR FRACTURES OF THE DISTAL HUMERUS - METHODS AND RESULTS IN 13 ADULTS

We reviewed the results in 13 adults of secondary reconstruction of ma lunited and ununited intra-articular distal humeral fractures. Their a verage age was 39.7 years, and preoperatively all had pain, loss of mo tion and functional disability; the average are of motion was only 43 degrees and the average flexion contracture was 45 degrees. Nine patie nts had ulnar neuropathy. Elbow reconstruction, at an average of 13.4 months after the original injury, included osteotomy for malunion or d ebridement for nonunion, realignment with stable fixation and autogeno us bone grafts, anterior and posterior capsulectomy and ulnar neurolys is. The elbows were mobilised 24 hours postoperatively. There were no early complications and all nonunions and intra-articular osteotomies healed. After a mean follow-up of 25 months, the average arc of motion was 97 degrees with no progressive radiographic degeneration. Ulnar n erve function improved in all cases and clinical assessment using the Morrey score showed two excellent, eight good and three fair results. Reconstruction of intra-articular malunion and nonunion of the distal humerus in young active adults is technically challenging, but can imp rove function by restoring the intrinsic anatomy of the elbow.