Anatomical Reconstruction of Severe Bone Defect in the Humeral Condyle：A long-term Follow-up
1.Administration Office for Undergraduates，Second Military Medical University
2.Department of Orthopedics，Changhai Hospital of The Second Military Medical University
Abstract：Objective To explore the use of autogenous iliac bonegraft for the anatomical reconstruction of severe humeral condylar nonunion and bone defect after trauma.Methods From May 1996 to May 2014，28 patients (17 male，11 female) with humera condylar nonunion and bone defect were retrospectively analyzed.The average age was 38.5 years old (range 16～65).According to AO/ASIF system，primal fractures were classified.There were 9 type-A3，2 type-B1，6 type-C2 and 11 type-C3 fractures.The average span from trauma to this operation was 22.3 months (range 7～55).The approach of olecranon osteotomy was used in all patients.The medial and lateral humerus condyle was reconstructed with iliac autograft and shape memory compressive connector，cannulated nail，anatomical locking compressive plates were applied for fixation.Results 28 patients were followed with an average of 4.6(range 2.5～10.5) years.The averaged time of bone healing was 5.7(range 4～10) months.All the incisions healed primarily.There was no hardware failure，loss of reduction，secondary nonunion and tardive ulnar neuritis.Ectopic ossification before joint developed in one case and affected the joint function of elbow.According to modified Cassebaum scoring system，the results were excellent in 11 cases，good in 10 cases，fair in 6 cases and poor in 1 case.The excellent and good rate was 75%.Conclusion The humeral condylar bone defects seriously affect the function of elbow joint.Anatomical reconstruction of medial and lateral condyle by autogenous iliac bone can restore the shape of elbow and alignment.Through early function exercise，elbow joint function can improve evidently.
［1］Cannada L，Loeffler B，Zadnik MB，et al.Treatment of high-energy supracondylar intercondylar fractures of the distal humerus［J］.J Surg Orthop Adv，2011，20(4)：230-235.
［2］Bégué T1.Articular fractures of the distal humerus［J］.Orthop Traumatol Surg Res，2014，100(1)：55-63.
［3］Ali A，Douglas H，Stanley D.Revision surgery for nonunion after early failure of fixation of fractures of the distal humerus［J］.J Bone Joint Surg(Br)，2005，87(8)：1107-1110.
［4］Cassebaum WH.Open reduction of T& Y fractures of the lower end of the humems［J］.J Trauma，1969，9(11)：915-925.
［5］Coles CP，Barei DP，Nork SE，et al.The olecranon osteotomy：a six-year experience in the treatment of intraarticular fractures of the distal humerus［J］.Orthop Trauma，2006，20(3)：164-171.
［6］陆耀刚，顾伟民，付备刚，等.严重肱骨髁间骨折手术疗效不佳原因分析［J］.临床骨科杂志，2003，6(4)：351-353.
［7］Ring D，Gulotta L，Chin K，et al.Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus［J］.Orthop Trauma，2004，18(7)：446-449.
［8］Gainor BJ，Moussa F，Schott T.Healing rate of transverse osteotomies of the olecranon used in reconstruction of distal humerus fractures［J］.South Orthop Assoc，1995，4(4)：263-268.
［9］McCarty LP，Ring D，Jupiter JB.Management of distal humerus fractures［J］.Am J Orthop，2005，34(9)：430-438.
［10］王思群，吴建国，夏新雷，等.重建钢板固定和尺神经前置治疗肱骨髁间骨折［J］.中华骨科杂志，2003，23(8)：474-478.
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