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Total Elbow Arthroplasty for Management of Distal Humeral Nonunions

Gandhi, Maulik J., BSc (Hons), MBChB, MPhil, FRCS (T&O)*; Moores, Thomas S., BSc, MBChB, MMedSci, FRCS (T&O)*; Malhotra, Akshay, MBBS, FRCS (T&O)*; Hay, Stuart M., MBChB, FRCS (T&O)*,†

Techniques in Shoulder & Elbow Surgery: September 2018 - Volume 19 - Issue 3 - p 97–100
doi: 10.1097/BTE.0000000000000140
Research Articles

Distal humeral nonunions are challenging to manage. We share our experience of using total elbow arthroplasty (TEA) for a series of 7 chronic nonunions following trauma. The mean: age at TEA was 72 years; number of operations per patient before TEA was 2.3; time from sustaining a distal humerus fracture to TEA was 10 years. The means for Oxford elbow score: pre-TEA was 9.4 (3 to 14); post-TEA was 41.4 (34 to 47). Average follow-up was 24 months (6 to 62 mo). A Wilcoxon-Mann-Whitney test showed improvement in Oxford elbow score post-TEA was highly significant (P=0.002). Pre-TEA range of motion was essentially flail due to instability of the nonunion. Post-TEA all patients achieved functional range of pain-free motion with a minimum arc of 10 to 130 degrees with mean flexion of 137 degrees (130 to 150 degrees). We conclude that TEA can achieve excellent functional and patient reported outcomes following distal humeral nonunions even after multiple surgeries and a considerable delay.

*The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry

The Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury, Shropshire, UK

The authors declare no conflict of interest.

Reprints: Maulik J. Gandhi, BSc (Hons), MBChB, MPhil, FRCS (T&O), Upper Limb Unit, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire SY10 7AG, UK (e-mail:

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