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Category: Volume 07 Issue 06 June 2019
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Title: Evaluation of Results of Intercondylar Fracture of Humerus in Adults Treated by Various Surgical Modalities

Authors: Dr P.V.V.S.N. Reddy, Dr L.Prasanna Kumar

 DOI: https://dx.doi.org/10.18535/jmscr/v7i6.152

Abstract

The intercondylar fractures of humerus were treated conservatively because of lack of experience of individual surgeon and rarity of these fractures. Conservative treatment of intercondylar fractures of humerus resulted in loss of elbow movement and permanent disability. Any treatment which requires prolonged immobilization risks loss of elbow function from fibrosis or ankylosis of the joint. Due to the above problems and the recent advances which made understanding of the joint mechanics and alignment better, the need of restoration has been understood. Later, to restore the joint, many surgeons tried closed manipulation, skeletal traction and percutaneous restoration of fragments but could not achieve good results. In the recent years, with fabrication of newer implants and with better surgical exposures, results of patients with intercondylar fractures of humerus have improved a lot. In spite of all these it is well known that anyone who has operated upon these badly broken and comminuted fractures of the lower end of humerus must have been impressed by the extreme difficulty of fixing the fragments in their proper position 4.  The present study is to evaluate the results of intercondylar fractures of distal humerus treated and in management with various surgical modalities. 20 cases of intercondylar fractures of humerus have been done by open reduction and internal fixation, 10 cases had excellent results, 5 had good, 3 had fair and 2 had poor results in our study. In summary, the concept of open reduction and internal fixation of intercondylar fractures of the humerus with dual plates is very valuable, in restoring articular surface and early rehabilitation decreasing morbidity, resulting good results.

References

  1. Gupta R- Intercondylar fractures of distal humerus in adults. Injury. 1996 Oct;27(8):569-72.
  2. Rockwood & Green's Fractures in Adults, 6th Edition Copyright A©2006 Lippincott Williams & Wilkins
  3. Jupiter JB, Morrey BF. Fractures of the distal humerus in the adult: The elbow and its disorders, 2nd ed. PhiIadelphia: wB Saunders,  1993:328a€"366.
  4. Huang Jl, Paczas M, Hoyen HA, Vallier HA. Functional outcome after open reduction internal fixation of intra-articular fractures of the distal humerus in  the elderly. J Orthop Trauma. 2011 May;25(5):259-65.
  5. Ravikant Das, Arunesh Singh, Pranay Shrivastava, Atul Manoharrao “Long Term Outcome of Surgical Management of Intercondylar  Fracture of Humerus”. Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 40, May 18; 6954-6959, DOI: 10.
  6. Hongwei Chen, Dacheng Li, Jun Zhang & Xinwei Xiong: Comparison of treatments in patients with distal humerus intercondylar fracture: a systematic review and meta-analysis  613-625 | 2017, Published online: 14 Jun 2017
  7. Robinson CM, Hill RM, Jacobs N, Dall G, Court-Brown CM. Adult distal humeral metaphyseal fractures: Epidemiology and results of treatment.J  Orthop Trauma 2003;17(1):38-47.
  8. Palvanen M, Kannus P, Neimi S, Parkkari J. Secular trends in distal humeral fractures of elderly women: Nationwide statistics in Finland between 1970 and 2007. Bone 2010;46(5):1355-1358.
  9. Gay DM, Lyman S, Do H, Hotchkiss RN, Marx RG, Daluiski A. Indications and reoperation rates for total elbow arthroplasty: An analysis of trends in New York state. J Bone Joint Surg Am 2012;94(2): 110-17.
  10. Got C, Shuck J, Biercevicz A. Biomechanical comparision of parallel versus 90-90 plating of bicolumn distal humerus fractures with intra articular comminution. J Hand Surg Am 2012;37(12): 2512-2518.
  11. Stoffel K, Cunneen S, Morgan R, Nicholls R, Stachowiak G. Comparative stability of perpendicular versus parallel double-locking plating systems in osteoporotic comminuted distal humerus fractures. J Orthop  Res2008;20(1):12-20.
  12. Sabalic S, Kodvanj J, Pavic A. Comparative study of three models of extra articular distal humerus fracture osteosynthesis using the finite element method on an osteoporotic computational model.Injury 2013;44(suppl 3):S56-S61. 80
  13. Caravaggi P, Laratta JL, Yoon RS. Internal fixation of the distal humerus: A comprehensive biomechanical study evaluating current fixation techniques. J Orthop Trauma 2014;28(4):222-226.
  14. Berkes M, Garrigues G, Solic J. Locking and non-locking constructs achieve similar radiographic and clinical outcomes for internal fixation of  intra-articular distal humerus fractures. Hssj 2011;7(3): 244-50.
  15. Cassebaum WH :Operative treatment of T and Y Fractures of lower end of humerus, Am J Surg. 1952 Mar;83(3):265-70
  16. O‟Driscoll SW. Management of the smashed distal humerus. Orthop Clin N Amer. 2002;33:19-33.
  17. Henley MB; Intraarticular distal humerus fractures in adults. Orthop clin north Am.,1987;18(1): 11-23.
  18. Wang KC, Shih HN, Hsu KY, Shih CH. Intercondylar fractures of the distal humerus: Routine anterior subcutaneous transposition of the ulnar nerve in a posterior operative approach. J Trauma. 1994;36(6):770-3.
  19. . Jupiter JB, Neff U, Holzach P. Intercondylar fractures of the humerus: an operative approach. J Bone Joint Surg Am. 1985;67(2):226-38.
  20. Allende CA, Allende BT, Allende BL, Bitar I, Gonzalez G. Intercondylar  distal humerus fractures-surgical treatment and results. Chir Main. 2004 Apr;23(2):85-95.

Corresponding Author

Dr L.Prasanna Kumar

Dept. of Orthopaedics, ACSR Medical College & General Hospital, Nellore, A.P, India