Nonunions of the distal humerus: Open reduction and internal fixation

Nonunions of the distal humerus are rare. They usually occur following attempts at open reduction and internal fixation, but they can result subsequent to nonoperative treatment. Most patients will complain of pain and instability of the elbow. Options for treatment range from benign neglect to fusion. For patients who are physiologically young, are active, and have adequate bone without significant arthrosis, open reduction and internal fixation (ORIF) with iliac crest bone graft is the treatment of choice. Union and pain relief can be reliably obtained following ORIF treatment. Proper patient selection and treatment algorithms allow for improved motion and acceptable functional outcomes.