Extraarticular distal humeral nonunion: systematic review of literature
Abstract Background Distal humeral fractures accounted for ~1% of all fractures; however, they were prone to complications, including nonunion if left untreated or inadequately managed. Nonunion, which predominantly occurred at the supracondylar level, resulted in mechanical instability, functional...
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SpringerOpen
2025-07-01
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| Series: | Journal of Orthopaedics and Traumatology |
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| Online Access: | https://doi.org/10.1186/s10195-025-00861-y |
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| author | Giovanni Vicenti Enrico Guerra Elisa Pesare Giulia Colasuonno Marco Minerba Michele Loiodice Francesco Conte Paolo Sergi Giuseppe Solarino |
| author_facet | Giovanni Vicenti Enrico Guerra Elisa Pesare Giulia Colasuonno Marco Minerba Michele Loiodice Francesco Conte Paolo Sergi Giuseppe Solarino |
| author_sort | Giovanni Vicenti |
| collection | DOAJ |
| description | Abstract Background Distal humeral fractures accounted for ~1% of all fractures; however, they were prone to complications, including nonunion if left untreated or inadequately managed. Nonunion, which predominantly occurred at the supracondylar level, resulted in mechanical instability, functional impairment, and persistent discomfort. The most commonly employed surgical options included open reduction and internal fixation (ORIF), total elbow arthroplasty (TEA), and external fixation. This article provides a comprehensive assessment of these surgical procedures and shared clinical experiences related to these challenging cases. Methods A systematic review of literature was conducted using the PubMed database up to October 2024, with a focus on cases involving extraarticular distal humeral nonunions that were treated with ORIF, TEA, or Ilizarov techniques. Results A total of 25 studies involving 448 patients were encompassed in the review, with a mean patient age of 50 years and an average follow-up period of 48 months. Reported success rates for ORIF and TEA were 90% and 74%, respectively. A higher rate of fracture healing was demonstrated by ORIF, although functional outcomes were found to be comparable between the techniques. Complications such as infections and reduced range of motion (ROM) were documented. Conclusions The highest success rate in treating aseptic nonunions was associated with ORIF, highlighting the importance of stable fixation, bone grafting, and meticulous preoperative planning. TEA was regarded as a viable option, particularly for patients with poor bone quality or complex, unreconstructible fractures. To optimize outcomes, surgical techniques were required to be customized on the basis of patient-specific factors and surgeon expertise. Further research is recommended to facilitate the comparison of long-term functional outcomes across different surgical approaches. Level of evidence: IV. |
| format | Article |
| id | doaj-art-a0f3b3dd3d4f4184914bbd8cda4583dc |
| institution | DOAJ |
| issn | 1590-9999 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Journal of Orthopaedics and Traumatology |
| spelling | doaj-art-a0f3b3dd3d4f4184914bbd8cda4583dc2025-08-20T03:05:55ZengSpringerOpenJournal of Orthopaedics and Traumatology1590-99992025-07-0126111110.1186/s10195-025-00861-yExtraarticular distal humeral nonunion: systematic review of literatureGiovanni Vicenti0Enrico Guerra1Elisa Pesare2Giulia Colasuonno3Marco Minerba4Michele Loiodice5Francesco Conte6Paolo Sergi7Giuseppe Solarino8Orthopedic and Trauma Unit, Department of Translational Biomedicine and Neuroscience (DiBraiN), School of Medicine, University of Bari Aldo Moro, AOU Consorziale “Policlinico”Shoulder and Elbow Unit, IRCCS Istituto Ortopedico RizzoliOrthopedic and Trauma Unit, Department of Translational Biomedicine and Neuroscience (DiBraiN), School of Medicine, University of Bari Aldo Moro, AOU Consorziale “Policlinico”Orthopedic and Trauma Unit, Department of Translational Biomedicine and Neuroscience (DiBraiN), School of Medicine, University of Bari Aldo Moro, AOU Consorziale “Policlinico”Shoulder and Elbow Unit, IRCCS Istituto Ortopedico RizzoliOrthopedic and Trauma Unit, Department of Translational Biomedicine and Neuroscience (DiBraiN), School of Medicine, University of Bari Aldo Moro, AOU Consorziale “Policlinico”Orthopedic and Trauma Unit, Department of Translational Biomedicine and Neuroscience (DiBraiN), School of Medicine, University of Bari Aldo Moro, AOU Consorziale “Policlinico”Orthopedic and Trauma Unit, Department of Translational Biomedicine and Neuroscience (DiBraiN), School of Medicine, University of Bari Aldo Moro, AOU Consorziale “Policlinico”Orthopedic and Trauma Unit, Department of Translational Biomedicine and Neuroscience (DiBraiN), School of Medicine, University of Bari Aldo Moro, AOU Consorziale “Policlinico”Abstract Background Distal humeral fractures accounted for ~1% of all fractures; however, they were prone to complications, including nonunion if left untreated or inadequately managed. Nonunion, which predominantly occurred at the supracondylar level, resulted in mechanical instability, functional impairment, and persistent discomfort. The most commonly employed surgical options included open reduction and internal fixation (ORIF), total elbow arthroplasty (TEA), and external fixation. This article provides a comprehensive assessment of these surgical procedures and shared clinical experiences related to these challenging cases. Methods A systematic review of literature was conducted using the PubMed database up to October 2024, with a focus on cases involving extraarticular distal humeral nonunions that were treated with ORIF, TEA, or Ilizarov techniques. Results A total of 25 studies involving 448 patients were encompassed in the review, with a mean patient age of 50 years and an average follow-up period of 48 months. Reported success rates for ORIF and TEA were 90% and 74%, respectively. A higher rate of fracture healing was demonstrated by ORIF, although functional outcomes were found to be comparable between the techniques. Complications such as infections and reduced range of motion (ROM) were documented. Conclusions The highest success rate in treating aseptic nonunions was associated with ORIF, highlighting the importance of stable fixation, bone grafting, and meticulous preoperative planning. TEA was regarded as a viable option, particularly for patients with poor bone quality or complex, unreconstructible fractures. To optimize outcomes, surgical techniques were required to be customized on the basis of patient-specific factors and surgeon expertise. Further research is recommended to facilitate the comparison of long-term functional outcomes across different surgical approaches. Level of evidence: IV.https://doi.org/10.1186/s10195-025-00861-yDistal humeral nonunionOpen reduction and internal fixation (ORIF)Total elbow arthroplasty (TEA)Healing rateInfection managementRevision surgery |
| spellingShingle | Giovanni Vicenti Enrico Guerra Elisa Pesare Giulia Colasuonno Marco Minerba Michele Loiodice Francesco Conte Paolo Sergi Giuseppe Solarino Extraarticular distal humeral nonunion: systematic review of literature Journal of Orthopaedics and Traumatology Distal humeral nonunion Open reduction and internal fixation (ORIF) Total elbow arthroplasty (TEA) Healing rate Infection management Revision surgery |
| title | Extraarticular distal humeral nonunion: systematic review of literature |
| title_full | Extraarticular distal humeral nonunion: systematic review of literature |
| title_fullStr | Extraarticular distal humeral nonunion: systematic review of literature |
| title_full_unstemmed | Extraarticular distal humeral nonunion: systematic review of literature |
| title_short | Extraarticular distal humeral nonunion: systematic review of literature |
| title_sort | extraarticular distal humeral nonunion systematic review of literature |
| topic | Distal humeral nonunion Open reduction and internal fixation (ORIF) Total elbow arthroplasty (TEA) Healing rate Infection management Revision surgery |
| url | https://doi.org/10.1186/s10195-025-00861-y |
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