Open Reduction and Internal Fixation of a Distal Humerus Fracture Through an Elbow Pseudoarticulation After Untreated Pediatric Dislocation

An 89-year-old man presented with right elbow pain after a low-energy fall. At age 2 years, he sustained an untreated distal humeral fracture dislocation, which resulted in progressive remodeling and formation of a functional pseudoarticulation. Despite permanent deformity, he maintained stable functional motion for decades and performed heavy manual labor. Imaging revealed a displaced distal humeral fracture through the chronically remodeled elbow. Open reduction and internal fixation with a variable-angle locking plate was performed, while the pseudoarticulation was intentionally left untreated. The patient regained his preinjury functional baseline. Conclusion: Fracture treatment should consider the clinical relevance of pre-existing but functional musculoskeletal abnormalities.