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Nonunion of the Distal Humerus
Nonunion of the distal humerus usually is located at the supracondylar level. Mobility at the nonunion site typically causes disabling pain and instability. Implants eventually break or loosen, often with a windshield-wiper effect of the screws in the bone, leading to further bone loss and further complicating internal
fixation. Scar tissue often compresses the ulnar nerve. Ultimately, the patient will be unable to use the arm for loading activities and/or position the forearm and hand against gravity. Factors commonly associated with distal humeral nonunions are multiple failed surgeries, smoking, infection, poor bone quality, and obesity. Most distal humeral nonunions can be managed with open reduction and internal fixation. Fixation is similar to that used to manage acute distal humeral fractures. However, surgical techniques for nonunion place greater emphasis on preoperative planning, careful surgical exposure, release, and bone grafting. This chapter presents the indications and contraindications for surgical treatment of distal humeral nonunion. Surgical techniques, outcomes from the literature, and strategies for avoiding pitfall and complications of surgery are also discussed.