Risk Factors for Non-Union after Open Reduction and Internal Fixation in Patients with Distal Humerus Fractures

Abstract

Background: Only a few studies have reported on the risk factors for non-union after open reduction and internal fixation (ORIF) in distal humerus fractures. Methods: We retrospectively reviewed 155 patients who underwent ORIF for distal humerus fractures from January 2008 to June 2020. Various patient factors, including body mass index (BMI), diabetes mellitus (DM), and combined fracture, as well as surgical factors, including fixation methods (e.g., orthogonal plate/parallel plate/single plate/tension bend wiring [TBW]) and combined fracture operations, were evaluated as risk factors for non-unions. Results: Among the patient factors, BMI (25.0 ± 3.4 vs. 22.7 ± 3.4, p = 0.032), DM (5/13 [38.5%] vs. 20/142 [14.1%], p = 0.038) and combined fracture (5/13 [38.5%] vs. 16/142 [11.3%], p = 0.018) were significantly different between groups with non-union and union. Among the surgical factors, combined fracture operation (5 [38.5%] vs. 9 [6.3%], p = 0.002) and the fixation method (3 [23.1%]/1 [7.7%]/4 [30.8%]/5 [38.5%] vs. 84 [59.2%]/7 [4.9%]/40 [28.2%]/11 [7.7%], p = 0.005) showed a significant difference between groups with non-union and union. Multivariate regression analysis showed that combined fracture operation (OR 10.467; 95% CI 1.880–58.257; p = 0.007) and TBW (OR 9.176; 95% CI 1.474–57.135; p = 0.018) among the fixation methods posed as a significant risk factor for non-union. Conclusions: The risk of non-union increased in patients who underwent surgery for another fracture combined with distal humerus fracture and in patients who underwent ORIF with TBW.

Development and validation of predictive nomogram for postoperative non-union of closed femoral shaft fracture

“…Tsai et al 50 found that sex was not associated with fracture healing. Ku et al 51 analyzed the risk factors for non-union in patients with distal humeral fractures after open reduction and internal fixation and found that BMI was not a statistically significant factor, a finding that is consistent with the results of this study. Cheng et al 52 confirmed that serum albumin level affects fracture healing; however, we did not obtain similar results after including it.…”

Efficacy and safety of anterior transposition of the ulnar nerve for distal humerus fractures: A systematic review and meta-analysis

“…After distal humerus injury, there was a large number of local bone defect, and there was a risk of delayed or even non-union (31,32). Some studies have shown that the delay fracture recovery rate could reach 2%-10% after ORIF (33).…”

Weak Points of Double-Plate Stabilization Used in the Treatment of Distal Humerus Fracture through Finite Element Analysis

“…It is known, however, that stabilization should provide stable-enough fixation to obtain a union. It also should allow for an early rehabilitation process, as movement is essential for success in the final treatment due to the fact that the elbow is intolerant to immobilization [11][12][13].…”