Abstract
Objective: The treatment of multifragmentary, intraarticular fractures of the distal humerus is difficult, even in young patients with bone of good quality. Small distal fragment, diminished bone mineral quality and increased trauma-associated joint destruction make stable
joint reconstruction more problematic. The anatomically preshaped locking plates allow angular stable fixation for these complex fractures. We evaluated functional results of patients treated with open reduction and internal fixation with distal humerus locking plates for complex distal humerus fractures.
Methods: Thirty consecutive patients with articular fractures of the distal humerus were treated by open reduction and internal fixation with AO distal humerus plate system and locking reconstruction plates. According to AO/ASIF classification, there were 2 cases of type A2, 4 cases of type A3, 1 case of type B1, 1 case of type B2, 11 cases of type C1, 4 cases of type C2 and 7 cases of type C3. Open reduction with triceps splitting technique was used in all patients. The clinical and radiographic follow-up was performed and outcome measures included pain assessment, range of motion, and Mayo elbow performance score.
Results: Thirty patients were available for the final outcome analysis. There were 19 males and 11 females with an average age of 38.4 years (18-73 years). Clinical and radiological consolidation of the fracture was observed in all cases at an average of 11.6 weeks (9-14 weeks). The average follow-up was 12 months (10-18 months). Using the Mayo elbow performance score the results obtained were graded as excellent or good results in 23 patients (76.6%). One patient had superficial infection.. There were no cases of primary malposition or secondary displacement, implant failure. There were two cases of ulnar neuropathy which recovered conservatively.
Conclusion: Anatomically preshaped distal humerus locking plate system is useful in providing stable fixation for complex distal articular fracture and facilitating early postoperative rehabilitation. The low rate of implant failure in the present study indicates that the technique is promising and warrants further investigation.
Keywords: Humerus; Fractures, bone; Bone plates; Fracture fixation, internal.
References
- Robinson CM, Hill RM, Jacobs N, et al. Adult distal humeralmetaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma 2003;17(1):38-47.
- Ring D, Jupiter JB. Fractures of the distal humerus. Orthop Clin North Am 2000;31 (1):103-13.
- Ring D, Jupiter JB. Complex fractures of the distal humerus and their complications. J Shoulder Elbow Surg 1999;8(1): 85-97.
- Korner J, Lill H, Müller LP, et al. Distal humerus fractures in elderly patients: results after open reduction and internal fixation. Osteoporos Int 2005;16 Suppl 2:S73-9.
- Schildhauer TA, Nork SE, Mills WJ, et al. Extensor mechanism- sparing paratricipital posterior approach to the distal humerus. J Orthop Trauma 2003;17(5):374-8.
- Jupiter JB, Mehne DK. Fractures of the distal humerus. Orthopedics 1992;15(7): 825-33.
- McKee MD, Wilson TL, Winston L, et al. Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach. J Bone Joint Surg Am 2000;82(12):1701-7.
- Shimamura Y, Nishida K, Imatani J, et al. Biomechanical evaluation of the fixation methods for transcondylar fracture of the humerus: ONI plate versus conventional plates and screws. Acta Med Okayama 2010;64(2):115-20.
- Huang TL, Chiu FY, Chuang TY, et al. The results of open reduction and internal fixation in elderly patients with severe fractures of the distal humerus: a critical analysis of the results. J Trauma 2005;58(1):62-9.
- Imatani J, Ogura T, Morito Y, et al. Custom AO small T plate for transcondylar fractures of the distal humerus in the elderly. J Shoulder Elbow Surg 2005;14(6):611-5.
- Jupiter JB. The management of nonunion and malunion of the distal humerus—a 30-year experience. J Orthop Trauma 2008;22 (10):742-50.
- Wong AS, Baratz ME. Elbow fractures: distal humerus. J Hand Surg Am 2009;34(1):176-90.
- Morrey BF, An KN, Chao EY. Functional evaluation of elbow. In: Lampert R, ed. The elbow and its disorders. 3rd ed. Philadelphia: WB Saunders, 2000:74-83.
- Gupta R, Khanchandani P. Intercondylar fractures of the distal humerus in adults: a critical analysis of 55 cases. Injury 2002;33(6):511-5.
- Doornberg JN, van Duijn PJ, Linzel D, et al. Surgical treatment of intra-articular fractures of the distal part of the humerus. Functional outcome after twelve to thirty years. J Bone Joint Surg Am 2007;89(7):1524-32.
- O’Driscoll SW. Optimizing stability in distal humeral fracture fixation. J Shoulder Elbow Surg 2005;14(1 Suppl S):186S- 94S.
- McKee MD, Kim J, Kebaish K, et al. Functional outcome after open supracondylar fractures of the humerus. The effect of the surgical approach. J Bone Joint Surg Br 2000;82(5):646-51.
- Kundel K, Braun W, Wieberneit J, et al. Intraarticular distal humerus fractures. Factors affecting functional outcome. Clin Orthop Rela Res 1996;(332):200-8.
- Korner J, Lill H, Müller LP, et al. The LCP-concept in the operative treatment of distal humerus fractures—biological, biomechanical and surgical aspects. Injury 2003;34 Suppl 2:B20-30.
- Jacobson SR, Glisson RR, Urbaniak JR. Comparison of distal humerus fracture fixation: a biomechanical study. J South Orthop Assoc 1997;6(4):241-9.
- Robinson CM. Fractures of the distal humerus. In: Bucholz RW, Heckman JD, Court-Brown C, et al, eds. Rockwood and Green’s fracture in adults. 6th ed. Philadelphia: Lipincott Williams & Wilkins, 2006:1051-116.
- Gofton WT, MacDermid JC, Patterson SD, et al. Functional outcome of AO type C distal humeral fractures. J Hand Surg Am 2003;28(2):294-308.
- Greiner S, Haas NP, Bail HJ. Outcome after open reduction and angular stable internal fixation for supra-intercondylar fractures of the distal humerus: preliminary results with the LCP distal humerus system. Arch Orthop Trauma Surg 2008;128(7): 723-9.
- Chi-Fat C, Grace Y, Frankie KL. Fixation of distal humeral fracture in elderly patient by locking compression plate. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2009;23(11):1285-9.
Corresponding Author
Dr Imran Qayoom
Postgaduate Scholar, Department of Orthopaedics, GMC Srinagar, India
DOI: https://dx.doi.org/10.18535/jmscr/v8i9.24
