Total Elbow Arthroplasty for Management of Distal Humeral Nonunions

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Distal humeral nonunions are challenging to manage. We share our experience of using total elbow arthroplasty (TEA) for a series of 7 chronic nonunions following trauma. The mean: age at TEA was 72 years; number of operations per patient before TEA was 2.3; time from sustaining a distal humerus fracture to TEA was 10 years. The means for Oxford elbow score: pre-TEA was 9.4 (3 to 14); post-TEA was 41.4 (34 to 47). Average follow-up was 24 months (6 to 62 mo). A Wilcoxon-Mann-Whitney test showed improvement in Oxford elbow score post-TEA was highly significant (P=0.002). Pre-TEA range of motion was essentially flail due to instability of the nonunion. Post-TEA all patients achieved functional range of pain-free motion with a minimum arc of 10 to 130 degrees with mean flexion of 137 degrees (130 to 150 degrees). We conclude that TEA can achieve excellent functional and patient reported outcomes following distal humeral nonunions even after multiple surgeries and a considerable delay.

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