Objective: To discuss the strategy of condylar reconstruction in the treatment of refractory condylar nonunion and defect of humerus.
Methods: From September 1998 to September 2005, 18 patients with refractory condylar nonunion concomitant withdefect of humerus were treated. The series included 12 males and 6 females, aged 18 to 60 years. According to AO/ASIF system, primal fractures were classified, including 5 cases of type A3, 2 cases of type B1, 4 cases of type C2 and 7 cases of type C3 fractures. Condylar nonunion and defect of humerus were confirmed by preoperative X-ray. Defective bone mass was 1-4 cm2. The mean extension and flexion of elbow joint was 21.5 degrees (5-65 degrees) and 95.8 degrees (85.0-123.5 degrees) respectively. According to Cassebaum scoring system, the excellent and good rate was 27.8% (excellent in 1 case and good in 4 cases). Time from injury to operation averaged 22.8 months (7-52 months). All patients were operated with approach of olecranon osteotomy. Bone defect was reconstructed with iliac autograft. Shape memory compressive connector, Kirschner wire, cannulated nail, anatomic plates and reconstruction plates were used to fix.
Results: Eighteen patients were followed up 12-86 months (mean 27.6 months). All the incisions healed by first intention. No bone block displacement,loosening or breakage of internal fixation occurred. The time of bone union averaged 5.7 months (4-8 months). The mean extension and flexion of elbow joint were 11.4 degrees (0-44.5 degrees) and 128.6 degrees (105.5-144.5 degrees) 1 year after operation. Ectopicossification formed in 1 case at anterior part of elbow 4 months after operation. According to Cassebaum scoring system,the results were excellent in 8 cases, good in 6 cases, fair in 3 cases and poor in 1 case. The excellent and good rate was 77.8%.
Conclusion: The shape of humeral condyle can be reconstructed with iliac autograft. Compressive internal fixation of bone block can promote bone union. Anatomical reconstruction, rigid internal fixation and early function exercise can improve the function of elbow joint evidently.