Arch Hand Microsurg.  2020 Mar;25(1):39-45. 10.12790/ahm.19.0056.

Autogenous Inlay Bone Graft for Distal Humerus Nonunion with Metaphyseal Bone Defect: A Technical Note

• Lee YS
• Kim D
• Kang MS
• Park JH
• Lee SU

• KMID: 2501109
• DOI: http://doi.org/10.12790/ahm.19.0056

Abstract

Distal humeral nonunion is one of the most concerned complications in elbow trauma. When bone loss at the fracture site is carried out due to nonunion, metaphyseal bone defect occurs. Therefore positioning of anatomical locking plate becomes difficult owing to abnormal bone contour, and fixation of small nonunion fragment is challenging. We introduce a good method of anatomical locking plate fixation with autogenous inlay strut bone graft for internal fixation. This technique is to insert autogenous inlay bone into the proximal medullary canal and hole of distal bone fragment which will lead to achieve correction of the anatomical alignment, length and rotation deformity. The inlay grafting is reduced to the shaft with two crossed K-wires temporarily. Definitive fixation is performed with locking plates, and autogenous bone graft is added at the defect site.

Keyword

Distal humerus; Nonunion; Inlay bone graft

Figure

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  Fig. 1. Plain radiographs of a 67-year-old female patient show distal humerus nonunion with metaphyseal bone defect.

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  Fig. 2. Preoperative computed tomography findings.

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  Fig. 3. Intraoperative findings of a 67-year-old female patient show distal humerus nonunion with metaphyseal bone defect.

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  Fig. 4. Intraoperative findings of strut bone graft from anterosuperior iliac spine.

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  Fig. 5. Autogenous pillar insertion into proximal medullary canal and hole of distal bone fragment.

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  Fig. 6. Temporary fixation by crossing K-wires (×2).

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  Fig. 7. Intraoperative findings after dual plate fixation.

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  Fig. 8. Postoperative simple radiographs.

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  Fig. 9. Postoperative simple radiographs 6 months post-surgery.

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  Fig. 10. Simple radiographs of a 86-year-old female patient show distal humerus transcondyle fracture.

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  Fig. 11. Simple radiographs of a 86-year-old female patient show distal humerus transcondyle nonunion after previous operation.

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  Fig. 12. Computed tomography coronal view and 3D view shows distal humerus transcondyle nonunion with fixation failure.

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  Fig. 13. Postoperative simple radiographs.

Reference

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