Treatment of nonunions and malunions around the elbow

Nonunions and malunions around the elbow are often due to incorrect initial treatment of a fracture. We have to differentiate between nonunions and ma lunion of adults and children. There are general principles for the treatme nt of nonunions and malunions of the distal humerus. They should not always be treated by decortication, internal fixation and bone graft. Removal of non-united fragments or a correction osteotomy may be good alternatives. A correct surgical approach and a biologically accurate osteosynthesis are necessary for good joint mobility, whereby the most difficult problem is to regain extension. An arthrolysis is not normally necessary during the firs t operation of a non- or malunion. It can be carried out, if necessary, on removal of implants. If these principles are followed,then the operation is usually successful a nd the patient satisfied. If treatment fails,the possibility of a joint rep lacement or an arthrodesis should not be forgotten.