Surgical Approach and Internal Fixation Techniques for Intra-Articular Distal Humerus Fracture With Coronal Shear Capitellar Fracture

Introduction: Distal humerus fracture in adults particularly complete articular (AO/OTA Type C) remain some of the most difficult injuries to manage. Complex anatomy of distal humerus combined with multifragmented fracture, sparse soft tissue cover with adjacent neurovascular structures poses great difficulty for treatment. Goal of treatment is to obtain a painless, stable and mobile elbow joint through a systematic approach. Aim: to study the functional outcome of surgical management of complete articular distal humerus fracture in adults. Method: a prospective study comprising of 20 patients treated surgically with open reduction and internal fixation using Orthogonal plating (dorsolateral and medial 3.5mm LCP) through trans olecranon approach. Result: Mean age of patients was 36.6 years (range 19 to 58 years) with male dominance, most fractures were of type 13C1 (AO/OTA). RTA accounts for most common mode of injury, majority of them being left sided. Mean operative time was 130 minutes. Complications included one case of superficial infection, 3 cases of ulnar neuropathy and non-union in 2 cases. Mean range of motion of elbow was 89 degree. Functional outcome assessed using Mayo Elbow Performance Score (MEPS) shown Excellent result in 12 cases, good to fair results in 6 and poor result in 2 cases. Conclusion: Anatomical restoration of joint surface and rigid internal fixation with bicolumnar orthogonal plating allowing early range of motion is the key for obtaining good functional results in complete articular distal humerus fractures. However, outcomes do deteriorate with increasing fracture complexity.

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Management of Distal Humerus Fractures With Jess Fixator

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v3i4.24259 ◽

2015 ◽

Vol 3 (4) ◽

pp. 16-20

Author(s):

Prakriti Raj Kandel ◽

Kishor Man Shrestha ◽

Laxmi Pathak

Keyword(s):

Distal Humerus ◽

Humerus Fracture ◽

Medical Sciences ◽

Distal Humerus Fracture ◽

Fixation Technique ◽

Fixation Techniques ◽

Humerus Fractures ◽

The Mean ◽

Distal Humerus Fractures

INTRODUCTION: Fractures of distal humerus are rare comprising approximately 2% of all fractures and a third of all humerus fractures. Even with the development of newer fixation techniques, the treatment of distal humerus fractures remains a great challenge to any orthopaedic surgeon. Thus this present study was conducted to evaluate the results of Joshi's External Stabilization System (JESS) in the management of distal humerus fracture with or without intercondylar extension. MATERIALS AND METHODS: This retrospective study was conducted by collecting records of thirty two adult patients who sustained distal humerus fracture and were managed with JESS fixation under anaesthesia over a period of two years in Universal College of Medical Sciences Teaching Hospital (UCMSTH) after obtaining permission from Institutional ethical committee. RESULTS: According to AO (Arbeitsgemeinschaft für Osteosynthesefragen) classification, 2 patients had C1 fracture and 30 patients had C2 fractures. The mean duration of JESS application was 16 weeks. The mean follow up was 8 months. The functional outcome was evaluated by using Cassebaum's functional rating system. Among C1 fractures, 50% showed fair and 50% showed good result whereas among C2 fractures, 40% showed good, 46.66% showed fair and 13.33% showed poor results. CONCLUSIONS: JESS fixation technique represents a viable option in the management of open as well as close intercondylar fractures of the distal humerus.

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Total Elbow Arthroplasty Gives Good Functional Outcome in Distal Humerus Fracture with Pre-existing Chronic Elbow Dislocation

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1016/j.jotr.2017.04.002 ◽

2018 ◽

Vol 24 (1) ◽

pp. 60-65

Author(s):

Chan Hing Shing ◽

Ho Sheung Tung

Keyword(s):

Internal Fixation ◽

Elbow Dislocation ◽

Distal Humerus ◽

Total Elbow Arthroplasty ◽

Humerus Fracture ◽

Distal Humerus Fracture ◽

Elbow Arthroplasty ◽

Flexion Extension ◽

Long Stem ◽

Chronic Elbow Dislocation

Distal humerus fracture with concomitant chronic elbow dislocation is difficult to manage by open reduction and internal fixation, while total elbow arthroplasty (TEA) is an effective treatment for acute fracture or failed internal fixation of distal humerus fracture in elderly patients with osteoporosis. We present a case of an 86-year-old woman who suffered from acute distal humerus fracture in the presence of chronic elbow deformity from elbow dislocation since childhood at the age of 10 years. This was treated with TEA using Coonrad/Morrey prosthesis with long stem and long flange humerus components and cerclage wiring of humeral condyle. Postoperatively, elbow mobilization was started early within a hinged elbow brace. There was no operative complication. At the last follow-up 22 months after surgery, there was no pain and good elbow motion (20–130° flexion–extension arc, full supination and pronation to neutral) was obtained. The Mayo Elbow Performance Score was 100. There was incorporation of the bone graft at the anterior flange with no radiographic loosening of the prosthesis. This case shows that TEA can yield a gratifying clinical result and efficiently resolves two problems with one solution.

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205 Biomechanical Study on Internal Fixation Devices for Distal Humerus Fracture (2nd Report)

The Proceedings of Conference of Hokuriku-Shinetsu Branch ◽

10.1299/jsmehs.2014.51._205-1_ ◽

2014 ◽

Vol 2014.51 (0) ◽

pp. _205-1_-_205-2_

Author(s):

Yuji TANABE ◽

Ryohei FUJITA ◽

Keyword(s):

Internal Fixation ◽

Distal Humerus ◽

Biomechanical Study ◽

Humerus Fracture ◽

Distal Humerus Fracture ◽

Fixation Devices

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Radiological and functional outcome of open reduction and internal fixation of extra articular distal humerus fracture using anatomical plate

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v9i12.22 ◽

2021 ◽

Vol 09 (12) ◽

Author(s):

Dr Kiran Gurung ◽

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Distal Humerus ◽

Humerus Fracture ◽

Distal Humerus Fracture

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Comparison of open reduction and internal fixation with total elbow arthroplasty for intra-articular distal humeral fractures in older age: a retrospective study

Clinics in Shoulder and Elbow ◽

10.5397/cise.2020.00052 ◽

2020 ◽

Vol 23 (2) ◽

pp. 94-99 ◽

Cited By ~ 1

Author(s):

Baik Jong Seok ◽

Lee Sung Hyun ◽

Hyun Tak Kang ◽

Tae Hyun Song ◽

Jeong Woo Kim

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Distal Humerus ◽

Humeral Fractures ◽

Total Elbow Arthroplasty ◽

Humerus Fracture ◽

Dash Score ◽

Distal Humerus Fracture ◽

Elbow Arthroplasty ◽

Distal Humeral Fractures

Background: Intra-articular distal humeral fractures can be surgically challenging. It remains under discussion whether open reduction internal fixation (ORIF) or total elbow arthroplasty (TEA) is more beneficial for treatment of the elderly. This study aimed to compare the clinical and functional outcomes of ORIF and TEA for managing intra-articular distal humerus fractures in patients aged 65 years or older.Methods: Patients who underwent ORIF (n=28) or TEA (n=43) for in intra-articular distal humerus fracture between May 2008 and December 2018 were reviewed. Range of motion, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, radiologic outcomes, and surgical complications were evaluated at the final follow-up visit.Results: The ORIF and TEA groups showed a mean arc of flexion–extension of 97°±21° and 101°±12°, respectively. The mean MEPS and DASH scores were 94±15 and 27±12 points, respectively, in the ORIF group and 81±27 and 47±28 points in the TEA group. This difference was statistically significant. The incidence of total complications was similar between the groups.Conclusions: In patients older than 65 years with intra-articular distal humerus fracture, ORIF had better outcomes than TEA.

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