Management of chronic neglected lateral condyle elbow non-union in adults: functional results of a cohort study and a proposed treatment algorithm.

PURPOSE: To evaluate surgical treatment of symptomatic non-union of lateral condylar elbow fractures in adults. METHODS: In this retrospective cohort study, 11 consecutive adult patients were surgically treated for symptomatic non-union of the lateral humeral condyle. Milch type I fracture non-unions (n = 3) were treated with medial closing wedge osteotomy and ulnar nerve transposition, while type II equivalents (n = 8) were treated with non-union fixation and bone grafting. Age at injury, age at referral, pre-operative symptoms, and pre-operative functional data (Modified An and Morrey functional rating index) were collected. RESULTS: Eleven patients (average age 20 years old) with varying symptoms attributable to non-union were surgically treated at a mean of 15.8 years following the initial fracture. Post-operative complications included one superficial infection and 17one radial nerve temporary neuropraxia. Pain, ulnar neuritis, and functional outcomes (Modified An and Morrey, mean 7.1 point improvement) improved significantly. However, the combined range of motion decreased by a mean of 11.4°. CONCLUSION: Our treatment algorithm for adults with chronic neglected and symptomatic non-union of the lateral humeral condyle improved functional outcomes in this cohort.