Outcomes Following Operative Management of Distal Humerus Nonunions

Objectives: To describe outcomes after distal humerus nonunion surgery and to identify risk factors for failure in the same population. METHODS: Design: Retrospective case series. Setting: Seven, academic, level I trauma centers. Patient selection criteria: Included were patients who underwent operative repair of a distal humerus (OTA/AO 13) nonunion and were ≥18 years old. Patients were excluded if they had clinical or serologic signs of infection prior to nonunion repair, or if their follow-up was less than 180 days and their surgery could not otherwise be classified as a success or failure. Outcome Measures and Comparisons: This study measured the rate of recalcitrant nonunion and complications following distal humerus nonunion surgery. It additionally evaluated associations between union rate and demographics, injury characteristics, and nonunion surgery characteristics. Results: Fifty-four patients with distal humerus nonunion were identified. Of the 30 included patients (mean age 47.5 (range 22-71), 18 (60%) male), 7 (23.3%) failed to unite after their index nonunion surgery at a study institution. Thirteen patients (43.3%) experienced one or more postoperative complications. While twenty-one of the 30 (70%) included patients initially sustained an open distal humerus fracture, all 7 patients (100%) who developed a recalcitrant nonunion initially sustained an open fracture. The use of bone graft or bone graft substitute relative to no graft, patient age, body mass index, smoking status, diabetes, and initial OTA/AO fracture classification were not associated with nonunion repair success rate (all p>0.05). Conclusion: This multicenter series challenged the concept that union rates are high, defined by the authors as >90%, following distal humerus nonunion surgery. Though limited by a small sample size that precluded multivariate regression, this study’s bivariate analysis suggests that an initially open distal humerus fracture may increase the risk of recalcitrant distal humerus nonunion. Modifiable risk factors were not associated with the success rate of nonunion surgery. These findings can be used to better inform patients’ expectations of results and complications following distal humerus nonunion surgery. Level of Evidence: Therapeutic level III

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Journal
Journal of Orthopaedic Trauma
Published
2026-10-22
DOI
https://doi.org/10.1097/bot.0000000000003298
Primary Topic
Bone fractures and treatments
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article
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article

Outcomes Following Operative Management of Distal Humerus Nonunions

Luke A. Lopas, Madhav A. Karunakar, Ishani Sharma, Samuel L. Posey et al.
Journal of Orthopaedic Trauma
Bone fractures and treatments
article

Outcomes Following Operative Management of Distal Humerus Nonunions

Luke A. Lopas, Madhav A. Karunakar, Ishani Sharma, Samuel L. Posey, William Hunter Waddell, Kerry A. Danelson, Bradley J. Lauck, Benjamin J. Averkamp, Hassan Farooq, Mario Cuadra, Meghan K. Wally, Noah James Harrison, Julie Titter, Yu Min Suh, Elsa Rodriguez, William Todd Obremskey, Rodney Arthur, Nathaniel T. Koutlas, Roman M. Natoli, Alexander A. Hysong, Anna N. Miller, Matthew J. Braswell, Zachary D. Randall, Laurence B. Kempton, Anthony V. Paterno, Mir Ibrahim Sajid, Ryan Serbin, Gisele Bailey, Juliette Sweeney, Andres Fidel Moreno-Diaz, Eddie K. Afetse, Andrew T. Chen, Lauren M. Tatman, Kate Hickson, Joseph R. Hsu, Martha B. Holden, Brandon Ponce, Kathryn Leighty, Kevin Phelps, Olivia Rice, Scott Lewis, Stephen Sims, Andrew Wohler, Donald Adams, Sharon Babcock, Laura E. Bess, Abigail Smith, Daniel E. Pereira, Kyle P. McNamara, Joseph Gutbrod, David Macknet, J. Michael Ruth, and the Evidence-Based Musculoskeletal Injury and Trauma Collaborative (EMIT), Hassan Mir, Josef Jolissaint, Ainsley Bloomer, Jason Halvorson, Joseph Burger, Julia Mastracci, Susan Odum, Sean Wrenn, Ziqing Yu, Alexis Amani LeMone, Luke A. Haag, Rachel B. Seymour, Eben Carroll, Cara Girardi, Thea Lance, Holly Pilson, Landon Bulloch, Zachary Hong, Samuel Cohen-Tanugi, Christine Churchil, Deron Morrison, Sarah Pierrie, Alexander Padovano, Patrick Pallitto, William B. Haynes, Jenna Jones, Amber S. McKinney
article en

Abstract

Objectives: To describe outcomes after distal humerus nonunion surgery and to identify risk factors for failure in the same population. METHODS: Design: Retrospective case series. Setting: Seven, academic, level I trauma centers. Patient selection criteria: Included were patients who underwent operative repair of a distal humerus (OTA/AO 13) nonunion and were ≥18 years old. Patients were excluded if they had clinical or serologic signs of infection prior to nonunion repair, or if their follow-up was less than 180 days and their surgery could not otherwise be classified as a success or failure. Outcome Measures and Comparisons: This study measured the rate of recalcitrant nonunion and complications following distal humerus nonunion surgery. It additionally evaluated associations between union rate and demographics, injury characteristics, and nonunion surgery characteristics. Results: Fifty-four patients with distal humerus nonunion were identified. Of the 30 included patients (mean age 47.5 (range 22-71), 18 (60%) male), 7 (23.3%) failed to unite after their index nonunion surgery at a study institution. Thirteen patients (43.3%) experienced one or more postoperative complications. While twenty-one of the 30 (70%) included patients initially sustained an open distal humerus fracture, all 7 patients (100%) who developed a recalcitrant nonunion initially sustained an open fracture. The use of bone graft or bone graft substitute relative to no graft, patient age, body mass index, smoking status, diabetes, and initial OTA/AO fracture classification were not associated with nonunion repair success rate (all p>0.05). Conclusion: This multicenter series challenged the concept that union rates are high, defined by the authors as >90%, following distal humerus nonunion surgery. Though limited by a small sample size that precluded multivariate regression, this study’s bivariate analysis suggests that an initially open distal humerus fracture may increase the risk of recalcitrant distal humerus nonunion. Modifiable risk factors were not associated with the success rate of nonunion surgery. These findings can be used to better inform patients’ expectations of results and complications following distal humerus nonunion surgery. Level of Evidence: Therapeutic level III

Journal of Orthopaedic Trauma
University of North Carolina at Chapel Hill (US), Atrium Health Wake Forest Baptist (US), Dartmouth–Hitchcock Medical Center (US), Washington University in St. Louis (US), Methodist Hospital (US), Florida Orthopaedic Institute (US), Indiana University School of Medicine, Vanderbilt University Medical Center (US)
Openalex Percentile: Top 12%
Bone fractures and treatments
DOISourceOpenAlex
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