Use of a Hinged External Fixator for Elbow Instability After Severe Distal Humeral Fracture

This is a retrospective analysis of the clinical and radiological outcome in 11 patients with complex acute posttraumatic elbow instability after dislocation. These patients had also been treated with a hinged external fixator after open reduction, capsular and ligamentous reconstruction and internal fixation, because of an expected diminished compliance, to avoid a secondary dislocation of the internal fixation. Concentric stability and a sufficient range of motion of the elbow joint were achieved in all cases. Non-compliant patients were classified by the surgeon as not compliant or not able or not willing to cooperate post-operatively for various reasons, such as alcoholism, drug abuse, mental disability, cerebral trauma or senile dementia. Non-compliant patients had undergone open reduction and internal fixation of an acute posttraumatic unstable elbow. The addition of a hinged external fixator allows early intensive mobilization, and can protect and improve the clinical outcome after these complex elbow injuries. This evaluation remains, of course, largely subjective and decision making is not easy because in most cases, the patient was not known before surgery. Thus, the only patient exclusion criteria in this study was surgeon classification as “compliant”.

Download Full-text

Optimizing stability in distal humeral fracture fixation

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2004.09.033 ◽

2005 ◽

Vol 14 (1) ◽

pp. S186-S194 ◽

Cited By ~ 143

Author(s):

Shawn W. O’Driscoll

Keyword(s):

Fracture Fixation ◽

Humeral Fracture ◽

Distal Humeral Fracture

Download Full-text

Combined use of Kirschner wires and hinged external fixator for capitellar and trochlear fractures: a minimum 24-month follow-up

ANZ Journal of Surgery ◽

10.1111/ans.14924 ◽

2018 ◽

Vol 89 (3) ◽

pp. 196-200

Author(s):

Shu-Kun He ◽

Si-Chun Zhao ◽

Jin-Hai Guo ◽

Ting-Wu Qin ◽

Fu-Guo Huang

Keyword(s):

External Fixator ◽

Kirschner Wires ◽

Combined Use ◽

Hinged External Fixator

Download Full-text

The patient-specific implant created with 3D printing technology in treatment of a severe open distal humerus fracture with complete loss of the lateral column

Journal of Orthopaedic Surgery ◽

10.1177/2309499020960251 ◽

2020 ◽

Vol 28 (3) ◽

pp. 230949902096025

Author(s):

Suriya Luenam ◽

Arkaphat Kosiyatrakul ◽

Kantapat Phakdeewisetkul ◽

Chedtha Puncreobutr

Keyword(s):

Articular Surface ◽

Lateral Collateral Ligament ◽

Humeral Fracture ◽

Distal Humerus ◽

Patient Specific ◽

Iliac Crest Bone Graft ◽

Favorable Result ◽

Printing Technology ◽

Lateral Column ◽

Distal Humeral Fracture

The open distal humeral fracture associated with the major loss of the articular surface and bony structure is a challenging problem for orthopedic surgeons. In this case report, we describe a case of complete missing lateral column of the distal humerus with severe articular destruction of capitellum and lateral trochlear ridge which was treated with the patient-specific implant created with three-dimensional printing technology. Apart from anatomic replacement of the articular surface, the lateral collateral ligament complex and extensor muscle which are the key soft tissue stabilizers of elbow were repaired by reattaching their bony origins to the impacted iliac crest bone graft inside the implant. Due to the favorable result at 2-year follow-up, this modality is a potentially viable surgical option in treating of the severe open distal humeral fracture associated with entire lateral condylar damage.

Download Full-text

Operative Choice for Displaced Proximal Humeral Fractures in Adolescents with Open Visible Physis: A Comparative Study of External Fixator vs. Kirschner Wire

10.21203/rs.3.rs-33678/v1 ◽

2020 ◽

Author(s):

Pan Hong ◽

Saroj Rai ◽

Huabing Qian ◽

Ruikang Liu ◽

Jin Li

Keyword(s):

Clinical Outcomes ◽

External Fixator ◽

Operative Time ◽

Rating Scale ◽

Demographic Data ◽

Kirschner Wire ◽

Humeral Fracture ◽

Good Choice ◽

Proximal Humeral Fractures ◽

Humeral Fractures

Abstract Background: For adolescents of severely displaced proximal humeral fracture (PHF), surgery is a good choice yielding excellent outcomes. Kirchner wire (KW) is a cost-effective choice for fixation, and this study aims to compare the clinical outcomes of external fixator (EF) vs. KW for the treatment of PHF in adolescents. To the best of our knowledge, it is the first report on external fixator for PHF in children and adolescents.Methods: Patients of PHF operated in our institute, from January 2008 to January 2016, were reviewed retrospectively. Demographic data, including sex, age at the time of surgery, operated side, and hardware choice, were collected from the hospital database. Preoperative radiographs were reviewed and classified according to Neer-Horwitz classification. Shoulder function was evaluated during 12th month follow-up using rating scale of the American shoulder and elbow surgeons (ASES). Complications, including infection, malunion, nonunion, stiffness of the shoulder joint, and failure of fixation were also recorded.Results: Thirty-five patients, including 23 males and 12 females, were included in the EF group, whereas 40 patients, including 25 males and 15 females, were included in the KW group (P = 0.867). The average age of patients in the EF group was 13.3 ± 1.7 years, and that of KW was 13.6 ± 1.8 years (P = 0.409). Patients in both groups were followed-up for at least 12 months. The operative time in the EF group (42.4 ± 11.2, min) was significantly shorter than those in the KW group (54 ± 13.6, min), P < 0.001. The frequency of fluoroscopy in the EF group (12 ± 2.4) was significantly less than those in the KW group (17 ± 2.8), P < 0.001. The rate of open reduction was significantly higher in KW (35%) group than those in the EF group (0%), P < 0.001. There was no nonunion, malunion cases in both groups.Conclusion: External fixator is superior to Kirschner wire in the treatment of proximal humeral fractures in adolescents with shorter operative time, lower rate of ORIF and comparable clinical outcomes.

Download Full-text