Open Reduction and Internal Fixation Using Double Plating with Biological and Artificial Bone Grafting of Aseptic Non-unions of the Distal Humerus: Clinical Results

Giuseppe Rollo; Giovanni Vicenti; Roberto Rotini; Ante Prkic; Denise Eygendaal; Luigi Meccariello

doi:10.5005/jp-journals-10080-1533

Open Reduction and Internal Fixation Using Double Plating with Biological and Artificial Bone Grafting of Aseptic Non-unions of the Distal Humerus: Clinical Results

Strategies Trauma Limb Reconstr. 2021 Sep-Dec;16(3):144-151. doi: 10.5005/jp-journals-10080-1533.

Authors

Giuseppe Rollo¹, Giovanni Vicenti², Roberto Rotini³, Ante Prkic⁴, Denise Eygendaal⁵, Luigi Meccariello¹

Affiliations

¹ Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
² Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Policlinico Consorziale, Bari, Italy; Orthopaedic and Trauma Unit, Bari, Italy.
³ Shoulder and Elbow Unit, "Rizzoli" Orthopaedic Institute, Bologna, Italy.
⁴ Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands.
⁵ Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands; Department of Orthopedic Surgery, AUMC, Amsterdam, The Netherlands.

Abstract

Aim: Intra-articular non-union of fractures is an uncommon but complex problem because in general, it is characterised by marked instability, pain, strength loss and significant functional limitation. The aim of this study is to report our prospective medium-term outcomes of the treatment of intra-articular, distal humeral aseptic non-unions using open reduction and internal fixation, augmented with artificial bone.

Materials and methods: A retrospective case series of 16 patients with intra-articular, aseptic non-unions of the distal humerus was analysed for range of motion, pain, Mayo Elbow Performance Scores (MEPS) and Oxford Elbow Scores (OES) after 12 months. Mean age was 44 years (range, 18-84 years) and mean total follow-up was 43 months (range, 24-62 months).

Results: All subjective and objective scores were significantly higher 12 months after treatment with internal fixation and artificial bone augmentation; the mean improvement on the MEPS was 18 points and 17 points on the OES. All patients returned to work, most without limitations. Autografts had worse outcomes compared to allografts regarding post-operative pain and time to return to work. No adverse events related to the artificial bone augmentation were seen and all fractures consolidated.

Conclusion: The use of two locking plates and bone graft augmentation with autografts or allografts with artificial bone grafts is a successful treatment of intra-articular distal humeral non-unions after hardware failure or biological limitations.

Clinical significance: The use of artificial bone in the treatment of septic non-unions of the upper limb is safe. When no autograft is possible because of concurrent morbidity, it can be used alone or combined with an allograft to reconstruct the affected bone without leading to extra morbidity or complications.

How to cite this article: Rollo G, Vicenti G, Rotini R, et al. Open Reduction and Internal Fixation Using Double Plating with Biological and Artificial Bone Grafting of Aseptic Non-unions of the Distal Humerus: Clinical Results. Strategies Trauma Limb Reconstr 2021;16(3):144-151.

Keywords: Artificial bone grafting; Aseptic non-union; Distal humerus; Patient-reported outcomes; Reconstruction; Revision surgery.