Vicenti Giovanni, Guerra Enrico, Pesare Elisa, Colasuonno Giulia, Minerba Marco, Loiodice Michele, Conte Francesco, Sergi Paolo, Solarino Giuseppe
Orthopedic and Trauma Unit, Department of Translational Biomedicine and Neuroscience (DiBraiN), School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", 70124, Bari, Italy.
Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, 40100, Bologna, Italy.
J Orthop Traumatol. 2025 Jul 21;26(1):48. doi: 10.1186/s10195-025-00861-y.
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.
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.
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.
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.
IV.
肱骨远端骨折占所有骨折的约1%；然而，它们容易出现并发症，如果不治疗或处理不当，包括骨不连。骨不连主要发生在髁上水平，会导致机械不稳定、功能障碍和持续不适。最常用的手术选择包括切开复位内固定术（ORIF）、全肘关节置换术（TEA）和外固定。本文对这些手术方法以及与这些具有挑战性病例相关的临床经验进行了全面评估。
使用PubMed数据库对截至2024年10月的文献进行系统综述，重点关注采用ORIF、TEA或伊里扎洛夫技术治疗的关节外肱骨远端骨不连病例。
该综述共纳入25项研究，涉及448例患者，患者平均年龄为50岁，平均随访期为48个月。报告的ORIF和TEA成功率分别为90%和74%。ORIF显示出更高的骨折愈合率，尽管发现两种技术的功能结果相当。记录了感染和活动范围（ROM）减小等并发症。
治疗无菌性骨不连的成功率最高与ORIF相关，突出了稳定固定、植骨和精心术前规划的重要性。TEA被认为是一种可行的选择，特别是对于骨质量差或复杂、无法重建骨折的患者。为了优化结果，需要根据患者的具体因素和外科医生的专业知识定制手术技术。建议进一步开展研究，以促进不同手术方法长期功能结果的比较。
IV级
