Low Extra-articular (Transcondylar) Fractures of the Distal Humerus

2012 ◽  
Vol 4 (4) ◽  
pp. 282-286
Author(s):  
Alexander A. Weening ◽  
Kim M. Brouwer ◽  
Margaritha Adams ◽  
David Ring
Keyword(s):  
Medical Record ◽  
Distal Humerus ◽  
Common Type ◽  
Fracture Type ◽  
Non Union ◽  
Results Of Treatment ◽  
Humerus Fractures ◽  
Distal Humerus Fractures ◽  
And Function

Background We reviewed our experience with low transcondylar, extra-articular distal humerus fractures to determine the prevalence of extra-articular distal humerus fractures, the percentage that are low transcondylar fractures, and the results of treatment. Material and methods One hundred seventy-four fractures of the distal humerus in adult patients were identified. Patients with at least 1-year of follow-up were evaluated based on the medical record according to the system described by Broberg and Morrey. Results Twenty-six fractures (15%) were extra-articular (AO Type A), 15 involved both the medial and lateral columns (8.6%), nine of which were low transcondylar fractures representing 5% of all fractures and 60% of the extra-articular bicolumnar fractures. Among the nine patients with low transcondylar fractures, two had non-union and three died within 3 months of injury. Among the eight patients with healed fractures after sufficient follow-up, patients with higher extra-articular distal humerus fractures had better motion and function than patients with low transcondylar fractures. Conclusions Transcondylar fractures are the most common type of extra-articular bicolumnar fracture and may be more common than previously recognized. Mortality within 3 months and non-union appear common with this fracture type.

scholarly journals Evaluation of functional outcome after osteosynthesis of intra articular distal humerus fracture with pre contoured locking compression plates

2020 ◽  
Vol 6 (6) ◽  
pp. 1215
Author(s):  
Faisal S. Mohammed ◽  
Akshay B. Ingale
Keyword(s):  
Functional Outcome ◽  
Distal Humerus ◽  
Distal Humerus Fracture ◽  
Performance Score ◽  
Mayo Elbow Performance Score ◽  
Locking Compression Plates ◽  
Humerus Fractures ◽  
Distal Humerus Fractures ◽  
Extensor Lag

<p><strong>Background:</strong> Intra articular distal humerus fractures are challenging and cumbersome to treat. Therefore osteosynthesis of such fractures is required. The aim of our study was to evaluate the functional outcome of intra articular distal humerus fractures AO type  13C by osteosynthesis using olecranon osteotomy with pre contoured locking compression plates in orthogonal plate configuration.</p><p><strong>Methods:</strong> Thirty patients were included in our study comprising of 18 males and 12 females. Mean age was 39.63 years with mean follow up of 34 weeks. 7 were AO type 13C1, 9 were AO type 13C2 and 14 were AO type 13C3. Osteosynthesis was done for all fractures by olecranon osteotomy approach. Functional outcome was assessed using mayo elbow performance score.</p><p><strong>Results:</strong> Mean flexion attained at the end of follow up was 127.56 degrees with mean extensor lag of 7.16 degrees. Mean arc of motion was 120.4 degrees. Mean mayo elbow performance score at the end of follow up was 80.36. Mayo elbow performance score in patients aged less than 40 years of age was not statistically significant as compared to patients more than 40 years of age. Functional outcome was also dependent on fracture subtype.</p><p><strong>Conclusions:</strong> Osteosynthesis of distal humerus fractures AO type 13C using pre contoured locking compression plates in orthogonal plate configuration by olecranon osteotomy provides excellent visualization of fracture and better functional outcome.</p>

scholarly journals A Limited Fixation, Olecranon Sparing Approach, for Management of Geriatric Intra-Articular Distal Humerus Fractures

2020 ◽  
Vol 11 ◽  
pp. 215145932095006
Author(s):  
Philip B. Kaiser ◽  
Erik T. Newman ◽  
Christopher Haggerty ◽  
Paul T. Appleton ◽  
John J. Wixted ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Distal Humerus ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Additional Surgery ◽  
Patient Reported ◽  
Functional Scores ◽  
Humerus Fractures ◽  
Distal Humerus Fractures

Purpose: We propose that geriatric comminuted intra-articular distal humerus fractures can be effectively treated with a limited fixation approach aimed at achieving varus/valgus stability with columnar fixation, but allowing intra-articular comminution to heal by secondary congruency against an intact olecranon, thus avoiding an olecranon osteotomy. Methods: Fifty-six elderly patients with AO 13-C type fractures, who underwent surgical fixation with ≥12-months of follow-up were retrospectively reviewed. Thirty patients were treated with intra-articular open reduction internal fixation (ORIF) with an olecranon osteotomy and 26 patients were treated with our limited fixation (L-ORIF) approach. Outcomes were range of motion (ROM), complications, additional surgery, and patient-reported outcome measures (PROMIS). Results: At final follow-up, the average elbow ROM was 97° (40°-155°) in the ORIF group and 86.5° (20°-145°) in the L-ORIF group. There was a trend toward more complications and additional surgery in the ORIF group. PROMIS scores for pain were 53.1 and 52.14, and PROMIS functional scores were 41.7 and 41.4 in the ORIF and L-ORIF group respectively. No differences in outcomes were statistically significant. Conclusion: A limited fixation technique based on achieving varus/valgus stability with columnar fixation, demonstrated equivalent outcomes in elderly patients with intra-articular distal humerus fractures when compared to intra-articular ORIF with an olecranon osteotomy

scholarly journals Management of Distal Humerus Fractures With Jess Fixator

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.

scholarly journals Elbow Posterolateral Rotatory Instability due to Cubitus Varus and Overuse

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Juan Martín Patiño ◽  
Alejandro Rullan Corna ◽  
Alejandro Michelini ◽  
Ignacio Abdon ◽  
Alejandro José Ramos Vertiz
Keyword(s):  
Tennis Elbow ◽  
Distal Humerus ◽  
Cubitus Varus ◽  
Rotatory Instability ◽  
Posterolateral Rotatory Instability ◽  
Humerus Fractures ◽  
Distal Humerus Fractures

A malunion as a complication of distal humerus fractures has been frequently linked with aesthetic problems but less frequently with posterolateral rotatory instability. We report 2 cases of childhood posttraumatic cubitus varus with subsequent posterolateral rotatory instability and their treatment with a minimum of 2 years of follow-up. The etiology of the so-called posterolateral rotatory instability of the elbow is mostly traumatic, but iatrogenic causes have also been described such as the treatment of tennis elbow and less frequently and chronically due to overuse and overload because of distal humerus malunion.

scholarly journals A muscle sparing posterior approach to the elbow joint for total elbow arthroplasty

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668499
Author(s):  
Ravi Sreenivasan ◽  
Pritish Singh ◽  
Simon Thomas ◽  
Anuj Jain ◽  
Harjoban Singh ◽  
...  
Keyword(s):  
Elbow Joint ◽  
Posterior Approach ◽  
Distal Humerus ◽  
Extensor Mechanism ◽  
Total Elbow Arthroplasty ◽  
Non Union ◽  
Elbow Arthroplasty ◽  
Muscle Sparing ◽  
Humerus Fractures ◽  
Distal Humerus Fractures

We describe a muscle sparing approach in which the triceps is elevated without injuring the muscle or disturbing its insertion. The entire extensor mechanism is preserved in continuity, thus preventing any extensor weakness. This can be used preferentially in cases of non-union intraarticular distal humerus fractures planned for Total Elbow Arthroplasty.

A PROSPECTIVE FOLLOW UP STUDY OF FUNCTIONAL OUTCOME OF SUPRACONDYLAR HUMERUS FRACTURE WITH INTERCONDYLAR EXTENSION TREATED WITH OLECRANON OSTEOTOMY APPROACH

2021 ◽  
pp. 76-79
Author(s):  
Pradeep Choudhary ◽  
Mahesh Bhati ◽  
Ramniwas Bishnoi ◽  
Aditya Srimal ◽  
Jayesh Chouhan
Keyword(s):  
Functional Outcome ◽  
Distal Humerus ◽  
Humerus Fracture ◽  
Distal Humerus Fracture ◽  
Range Of Movement ◽  
Mayo Elbow Performance Score ◽  
Humerus Fractures ◽  
Distal Humerus Fractures ◽  
Frequent Presence

Introduction- Olecranon osteotomy is standard approach for low transcondylar and intercondylar distal humerus fractures. Distal humerus fractures are difcult to manage successfully because of the local anatomic constraints, the frequent presence of comminution,displacement and osteopenia. We studied the functional outcome and complications following surgical xation using this approach. Material And Methods- A total 20 consecutive patients(male:15,female:5),having mean age 42.1yrs, of Distal Humerus fractures who will attend the casualty or O.P.D during the thesis period(June2018 to October2020) at Mahatma Gandhi Hospital & Mathuradas Mathur Hospital Jodhpur (Rajasthan) will be included in study group and managed surgically using olecranon osteotomy approach. Functional outcome was evaluated using the Mayo Elbow Performance Score(MEPS) and complications were observed. Results- Mean loss of extension was 10°.Mean exion achieved was 122.75°.Mean range of movement at treated elbow was 113°. All fractures united by the end of 3 months. Final results were excellent in 8 cases; good in 7 cases; fair in 4 and poor in one case. Most common complication in our study was discomfort due to hardware(6 cases). Supercial infection occurred in 2 cases. Screw/wire backout occurred in 2 cases. Elbow stiffness and malunion happened in one case. Functional outcome was also dependant on fracture subtype. Conclusion- Intraarticular distal humerus fracture treated with olecranon osteotomy approach had good articular exposure and surgical xation. This approach had good functional outcome and fewer complications.

scholarly journals Total Elbow Arthroplasty

2011 ◽  
Vol 5 (1) ◽  
pp. 115-123 ◽  
Author(s):  
Joaquin Sanchez-Sotelo
Keyword(s):  
Tumor Resection ◽  
Distal Humerus ◽  
Total Elbow Arthroplasty ◽  
Posttraumatic Osteoarthritis ◽  
Elbow Arthroplasty ◽  
Augmentation Techniques ◽  
Humerus Fractures ◽  
Distal Humerus Fractures ◽  
And Function ◽  
Spectrum Of Indications

Total elbow arthroplasty has continued to evolve over time. Elbow implants may be linked or unlinked. Unlinked implants are attractive for patients with relatively well preserved bone stock and ligaments, but many favor linked implants, since they prevent instability and allow replacement for a wider spectrum of indications. Inflammatory arthropathies such as rheumatoid arthritis represent the classic indication for elbow arthroplasty. Indications have been expanded to include posttraumatic osteoarthritis, acute distal humerus fractures, distal humerus nonunions and reconstruction after tumor resection. Elbow arthroplasty is very successful in terms of pain relief, motion and function. However, its complication rate remains higher than arthroplasty of other joints. The overall success rate is best for patients with inflammatory arthritis and elderly patients with acute distal humerus fractures, worse for patients with posttraumatic osteoarthritis. The most common complications of elbow arthroplasty include infection, loosening, wear, triceps weakness and ulnar neuropathy. When revision surgery becomes necessary, bone augmentation techniques provide a reasonable outcome.

Intra-articular Distal Humerus Fractures: Parallel Versus Orthogonal Plating

2021 ◽  
pp. 155633162110098
Author(s):  
Jack M. Haglin ◽  
David N. Kugelman ◽  
Ariana Lott ◽  
Rebekah Belayneh ◽  
Sanjit R. Konda ◽  
...  
Keyword(s):  
Distal Humerus ◽  
Open Reduction Internal Fixation ◽  
Fracture Repair ◽  
Chi Square ◽  
Locking Compression Plates ◽  
Dual Plating ◽  
Dual Plate ◽  
Humerus Fractures ◽  
Distal Humerus Fractures

Background: Dual-plating osteosynthesis is the standard treatment for Orthopedic Trauma Association (OTA)-type 13-C distal humerus fractures. However, optimal plate position is debated. Purpose: The purpose of this study was to evaluate dual-plate positioning following intra-articular distal humerus fracture repair by comparing outcomes between patients plated in parallel and those plated orthogonally following open-reduction, internal-fixation (ORIF) of intra-articular distal humerus fractures. Methods: All OTA-type 13-C intra-articular distal humerus fractures treated operatively at our institution over a 10-year period were reviewed. Clinical outcomes and complications were compared between those plated in parallel and those plated orthogonally. Data were analyzed using independent-samples t-tests, Mann-Whitney U tests, chi-square tests, and Fisher’s exact tests. Results: A total of 69 patients met inclusion criteria. Mean follow-up among this cohort was 19.3 months; 45 (64.8%) patients had orthogonal dual plating, and 24 (35.2%) had parallel plating. Groups did not differ with respect to demographics or duration of follow-up. Clinically, there were no significant differences in time to union, elbow arc of motion at any time point, or patient Mayo Elbow Performance Index (MEPI) scores at final follow-up. Furthermore, there were no differences in complications. Conclusion: Parallel and orthogonal plating following ORIF of distal humerus fractures with modern, contoured locking compression plates had similar outcomes in this study. This study represents the largest comparative series in the literature at the time of its writing. Both techniques may be considered when deciding on dual-plating technique for treating intra-articular distal humerus fractures.

scholarly journals Distal humerus fracture in patients over 70 years of age: results of open reduction and internal fixation

2020 ◽  
Author(s):  
Mohamed Moursy ◽  
Kilian Wegmann ◽  
Florian Wichlas ◽  
Mark Tauber
Keyword(s):  
Elderly Patients ◽  
Internal Fixation ◽  
Range Of Motion ◽  
Open Reduction ◽  
The Elderly ◽  
Distal Humerus ◽  
Non Union ◽  
Patient Satisfaction Scores ◽  
Distal Humerus Fractures

Abstract Background Due to the complexity of distal humerusfractures and often poor bone quality in elderly patients, these entities remain a challenge. However, because of a high rate of complications related to total elbow prostheses, reconstruction of distal humerus fractures should still be considered a therapeutic option, also in the elderly patient. The purpose of the present study was to investigate the clinical outcomes after open reduction and internal fixation and to evaluate whether the results justify reconstruction even in elderly patients. We hypothesized that despite advanced age, reasonable clinical results can be achieved, using a standardized surgical technique and aftertreatment protocol for the treatment of distal humerus fractures in elderly patients. Methods Between 2004 and 2012, 30 patients with a mean age of 78 years at the time of injury with a recent distal humerus fracture were evaluated. All patients underwent the identical aftertreatment protocol with no weight bearing for 6 weeks and weekly increasing range of motion. Follow-up rate was 90%. 22 patients were treated with double plate, 4 with single plate, and 1 with screw fixation only. Patients were evaluated based on clinical criteria. Primary outcome measures were Mayo Elbow Performance Score, VAS and joint range of motion, secondary was radiological evaluation. Results After a mean follow-up period of 3.8 years (min. 1 year, max. 9 years, SD ± 2), the average range of motion was flexion of 127° (min. 100°; max. 150°; SD ± 16.5) and average loss of extension of 20.9° (min. 5°; max. 40°; SD ± 11). Average pronation and supination was 68.3° (min. 0°; max. 90°; SD ± 25.3) and 75.3° (min. 0°; max. 90°; SD ± 19.7), respectively. Average Mayo Elbow Performance (MEPS) score was 88.7 (min. 60; max. 100; SD ± 12.1). 6 patients developed heterotopic ossification without significant effect on the clinical outcome. 7 patients had radiological evidence of at least partial non-union with one requiring revision, 2 discrete hardware dislocations were treated conservatively. There were no infections in the presented cohort. Our results regarding the surgical approach showed significantly higher patient satisfaction scores in the osteotomy group, compared to the group with Triceps-On Approach (PTOA). Conclusion The present data support indication for open reduction internal fixation (ORIF) even in the elderly patient. Advanced age should not be seen as a contraindication for ORIF of fractures of the distal humerus. Although the rate of complications is higher than in younger patients, complications such as non-union are often asymptomatic, patient satisfaction scores are high, and the possible devastating complications of failed elbow replacement can be evaded. Level of evidence IV.

scholarly journals Distal Humerus Fractures Managed With Elbow Hemiarthroplasty

2020 ◽  
Vol 4 ◽  
pp. 247154922096005
Author(s):  
JD Stephens ◽  
Brandon Kohrs ◽  
Logan Bushnell ◽  
Speros Gabriel ◽  
H Brent Bamberger
Keyword(s):  
Distal Humerus ◽  
Patient Survey ◽  
Open Reduction Internal Fixation ◽  
Weight Lifting ◽  
Assistive Device ◽  
Long Term Results ◽  
Functional Capabilities ◽  
Humerus Fractures ◽  
Distal Humerus Fractures

Background Distal humerus fractures not amenable to open reduction internal fixation (ORIF) present a unique dilemma, especially for patients that weight bear through assistive devices. The one accepted operative treatment for irreparable distal humerus fractures is total elbow arthroplasty (TEA). However, TEA commonly requires lifetime weight lifting restrictions and has limited long term results. Elbow hemiarthroplasty (EHA) represents an alternative treatment modality. This study reviews patients treated with EHA permitted to weight bear postoperatively. Methods Twelve patients underwent EHA for comminuted distal humerus fractures deemed non-reconstructable by ORIF. Patient survey data was collected retrospectively. All patients were allowed to weight bear as tolerated through the operative extremity. Outcome measures included Patient rated elbow evaluation (PREE), Mayo elbow performance score (MEPS), and whether revision surgery was required. Results The average MEPS score was 76.1 indicating fair outcomes and the average PREE score was 41. One patient required revision. Average follow up was 44.1 months. Three patients required an assistive device prior to injury. Discussion EHA serves as a viable option for non-reconstructable distal humerus fractures. EHA does not require a weight lifting restriction, which is a benefit over TEA. Overall, patients reported preserved functional capabilities but did report moderate pain. EHA demonstrated durability, although one patient required revision. Conclusion With growing interest in use of EHA, further studies are required to evaluate EHA as a superior treatment for patients with nonreconstructable traumatic distal humerus fractures; however, this study does support use in elderly patients with intermediate follow up.

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