Malunion of distal humeral fractures: current concepts

Abstract

The incidence of complex articular fractures of the distal humeral in adults has increased and will be growing in the future due to the greater incidence of high energy trauma and to the higher percentage of elderly population. Successful treatment is challenging for the needed balance between a stability of often comminuted fracture and early motion.Malunion is a common complication after distal humerus fractures, which is influenced by a variety of factors such as biology, particularly the blood supply of the metaphysis, the non-anatomical reduction of the fracture, the methods of fixation and mechanical failure. These can involve the intra-articular or extra-articular areas. Clinical presentation may be mainly with pain and instability as for cubitus varus or with disfunction and stiffness as for an intra-articular malunion. However, the symptoms will depend on the degree of articular surfaces damage and the degree of deformities in specific planes. The surgical treatment can be challenging varying from supracondylar osteotomies and re-contouring arthroplasty for extra-articular deformities to interposition arthroplasty and elbow replacement for intra-articular deformities.