Functional Outcome and Inflammatory Response of Patients with Extra-Articular Distal Humeral Fractures following Implantation of Anatomically Precontoured Locking Compression Plates through a Posterior Approach

Distal humeral fractures are challenging injuries to surgically correct and account for up to 2% of all adult fractures. Surgical management of extra-articular distal humeral fractures is challenging considering surgical approach, implant selection, and position of the implant owing to the availability of different precontoured implants and plate configurations. Anatomically precontoured locking compression plates (APLCPs) allow the placement of angular stable screws right underneath the reduced joint surface fragments. To date, there is a lack of evidence supporting its superiority to conventional locking plate osteosynthesis (LPO) in treating extra-articular distal humeral fractures. The objective of the study is to evaluate the efficacy and safety of APLCPs in the treatment of extra-articular distal humeral fractures. A total of 100 patients diagnosed with humeral fractures and receiving treatments in our hospital between May 2018 and May 2020 fulfilled inclusion and exclusion criteria and were randomly assigned to LPO and APLCP groups according to the odd-even of the order of hospital admission, 50 cases per groups. Clinical endpoints were assessed including operation time; in-bed time; length of hospital stay; volume of intraoperative blood loss; VSA scores before and 24, 48, and 72 h after surgery; MEPS scores before and 3, 6, and 12 months after surgery; range of motion, flexion, and extension of the elbow; serum levels of CK, CRP, and IL-6; and incidence of complications after surgery. It was found that the APLCP group exhibited shortened operation time and in-bed time, decreased length of hospital stay, and reduced volume of intraoperative blood loss compared to the LPO group (all P < 0.001 ). The two groups had declined VSA scores concomitant with increased MEPS scores after surgery in a time-dependent manner ( P < 0.001 ). Notably, the VSA scores in the APLCP group were all lower than those in the LPO group at indicated time points (24, 48, and 72 h) after surgery ( P < 0.001 ). Besides, the MEPS scores in the APLCP group were all higher than those in the LPO group at indicated time points (3, 6, and 12 months) after surgery ( P < 0.001 ). It was revealed that the patients receiving extra-articular distal humeral APLCP through posterior approaches exhibited greater ranges of motion, flexion, and extension of the elbow than those receiving LPO after surgery ( P < 0.001 ). The patients receiving extra-articular distal humeral APLCP through posterior approaches exhibited lower serum levels of IL-6, CRP, and CK than those receiving LPO after surgery (IL-6: P = 0.007 , CRP: P = 0.001 , CK: P = 0.001 ). The APLCP had a lower total incidence rate of complication than the LPO group (48.00% vs. 18.00%, P = 0.003 ). In conclusion, these data support the notion that the implantation of anatomically precontoured APLCP through a posterior approach allows for improved functional outcomes and attenuated inflammatory response and prevents the incidence of postoperative complications compared to conventional LPO for internal fixation of extra-articular distal humeral fractures.

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Clinical and functional outcomes after type B-C (AO/OTA) distal humeral fractures treated with locking compression plates: a retrospective study

Minerva Orthopedics ◽

10.23736/s2784-8469.20.04002-3 ◽

2021 ◽

Vol 72 (4) ◽

Author(s):

Carmine CITARELLI ◽

Federico SACCHETTI ◽

Giulio AGOSTINI ◽

Vittorio MATTUGINI ◽

Lorenzo ANDREANI ◽

...

Keyword(s):

Retrospective Study ◽

Functional Outcomes ◽

Humeral Fractures ◽

Type B ◽

Locking Compression Plates ◽

Distal Humeral Fractures

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A comparative study of the fracture union between long and short proximal femoral intramedullary nails antirotation in the treatment of intertrochanteric femur fractures in the elderly: a multicentric analysis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190793 ◽

2019 ◽

Vol 5 (2) ◽

pp. 288

Author(s):

B. Hari Krishnan ◽

S. K. Rai ◽

Rohit Vikas ◽

Manoj Kashid ◽

Pramod Mahender

Keyword(s):

Postoperative Complications ◽

Blood Transfusion ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Operation Time ◽

The Elderly ◽

Intertrochanteric Fractures ◽

Intraoperative Blood Loss ◽

Fracture Union ◽

Femur Fractures

Background: The objective of the study was to compare the fracture union of long vs. short proximal femoral intramedullary nail antirotation (PFNA) in the treatment of intertrochanteric fractures in elderly patients who was more than 60 years old.Methods: A retrospective analysis of 170 cases of intertrochanteric fractures of the femur (AO type A1 and A2) in the elderly was conducted. There were 64 males (37.6%) and 106 females (62.3%) with the age of 60–90 (mean age 75) years. The general demographic data of patients, operation time, intraoperative blood loss, length of hospital stay, blood transfusion rate, anterior thigh pain, postoperative complications like periprosthetic fractures, infections were recorded.Results: The short nail group also had a significantly shorter operation time (41.5±15.3 minutes vs. 62.5±25.3 minutes, p=0.002) and lower rate of postoperative transfusion (31.3% vs. 58.7%, p=0.041). However the length of hospital stay showed no significant differences. After surgery in short group there were 03 cases of periprosthetic fracture with a total incidence of 03%, however there were none in long nail group. At the end of the follow-up, all patients achieved bony union. The average fracture union time of the long nail group was (8.5±3.2) months, and the short nail group was (7.8±4.7) months, revealing no significant differences (p=0.09).Conclusions: Both the proximal femoral intramedullary long and short nail fixation has a good result in the form of fracture union in treating intertrochanteric femur fractures in the elderly. They showed no significant difference in terms of fracture union, hospital stay, and postoperative complications. The incidence of periprosthetic fractures and anterior thigh pain was slightly high in short nail group. In short intramedullary nailing group there was obvious decrease in the intraoperative blood loss, operation time and postoperative blood transfusion.

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Elbow fractures and dislocations

10.1093/med/9780199550647.003.012034 ◽

2011 ◽

Author(s):

John R. Williams ◽

Brian J. Holdsworth

Keyword(s):

Posterior Approach ◽

Humeral Fractures ◽

Ao Classification ◽

Articular Fractures ◽

Complex Fractures ◽

Elbow Fractures ◽

Distal Humeral Fractures

♦ These are very complex fractures to treat; the elbow is intolerant of immobilization in the adult♦ Posterior approach best for complex fractures♦ AO classification widely used♦ Most intra-articular fractures best internally fixed♦ Most distal humeral fractures require two plates.

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Functional Outcome Following Surgical Treatment of Intra-Articular Distal Humeral Fractures Through a Posterior Approach*

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-200012000-00003 ◽

2000 ◽

Vol 82 (12) ◽

pp. 1701-1707 ◽

Cited By ~ 150

Author(s):

MICHAEL D. McKEE ◽

TRACY L. WILSON ◽

LUCY WINSTON ◽

EMIL H. SCHEMITSCH ◽

ROBIN R. RICHARDS

Keyword(s):

Surgical Treatment ◽

Functional Outcome ◽

Posterior Approach ◽

Humeral Fractures ◽

Distal Humeral Fractures

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Outcomes and complications of distal humeral hemiarthroplasty for distal humeral fractures – A systematic review

Shoulder & Elbow ◽

10.1177/17585732211023100 ◽

2021 ◽

pp. 175857322110231

Author(s):

Ann M Wilfred ◽

Shakib Akhter ◽

Nolan S Horner ◽

Ahmed Aljedani ◽

Moin Khan ◽

...

Keyword(s):

Systematic Review ◽

Functional Outcomes ◽

Data Extraction ◽

Humeral Fractures ◽

Complication Rates ◽

Bias Assessment ◽

Operation Rate ◽

Distal Humeral Fractures ◽

The Mean ◽

Flexion And Extension

Background Distal humeral hemiarthroplasty has been performed for a variety of indications with the most common being management of distal humeral fractures. This systematic review evaluates the outcomes and complications of distal humeral hemiarthroplasty for this pathology. Methods We searched PubMed, EMBASE, and MEDLINE for studies reporting indications and outcomes of patients undergoing distal humeral hemiarthroplasty. Study screening, risk of bias assessment, and data extraction were performed. Summery statistics were provided. Results We included 11 studies ( N = 163) in this review. In all studies, the indication for distal humeral hemiarthroplasty was the presence of an intraarticular, comminuted, unreconstructable fracture. The mean post-operative MEPS, FullDASH, and QuickDASH (SD) scores were 83.6 (6.1) points, 25.4 (10.3), and 15.7 (7.4) points, respectively. The mean post-operative range of motion (SD) was 106° (11°) in the flexion and extension arc and 153° (19°) in the protonation and supination arc. The overall rate of adverse events and complication was 63%. The rate for major complications was 11%. The mean total revision rate was 4% (0% to 15) and total re-operation rate was 29% (0% to 88%). Conclusion Distal humeral hemiarthroplasty is a suitable option for unreconstructable distal humeral fractures and offers good functional outcomes with acceptable complication rates.

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Efficacy evaluation of three-dimensional printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1403-7 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Yuan-Wei Zhang ◽

Xin Xiao ◽

Wen-Cheng Gao ◽

Yan Xiao ◽

Su-Li Zhang ◽

...

Keyword(s):

3D Printing ◽

Blood Loss ◽

Three Dimensional ◽

Operation Time ◽

Varus Deformity ◽

Conventional Group ◽

Intraoperative Blood Loss ◽

Cubitus Varus ◽

Guide Plate ◽

Significant Difference

Abstract Background This present study is aimed to retrospectively assess the efficacy of three-dimensional (3D) printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity. Material and methods Twenty-five patients (15 males and 10 females) with the cubitus varus deformity from June 2014 to December 2017 were included in this study and were enrolled into the conventional group (n = 11) and 3D printing group (n = 14) according to the different surgical approaches. The operation time, intraoperative blood loss, osteotomy degrees, osteotomy end union time, and postoperative complications between the two groups were observed and recorded. Results Compared with the conventional group, the 3D printing group has the advantages of shorter operation time, less intraoperative blood loss, higher rate of excellent correction, and higher rate of the parents’ excellent satisfaction with appearance after deformity correction (P < 0.001, P < 0.001, P = 0.019, P = 0.023). Nevertheless, no significant difference was presented in postoperative carrying angle of the deformed side and total complication rate between the two groups (P = 0.626, P = 0.371). Conclusions The operation assisted by 3D printing osteotomy guide plate to correct the adolescent cubitus varus deformity is feasible and effective, which might be an optional approach to promote the accurate osteotomy and optimize the efficacy.

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Two and Three-Dimensional Computed Tomography for the Classification and Management of Distal Humeral Fractures

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.e.00944 ◽

2006 ◽

Vol 88 (8) ◽

pp. 1795-1801 ◽

Cited By ~ 94

Author(s):

Job Doornberg ◽

Anneluuk Lindenhovius ◽

Peter Kloen ◽

C. Niek van Dijk ◽

David Zurakowski ◽

...

Keyword(s):

Computed Tomography ◽

Three Dimensional ◽

Humeral Fractures ◽

Distal Humeral Fractures

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Subjective ulnar nerve dysfunction commonly following open reduction, internal fixation (ORIF) of distal humeral fractures and in situ decompression of the ulnar nerve

Strategies in Trauma and Limb Reconstruction ◽

10.1007/s11751-016-0271-5 ◽

2016 ◽

Vol 12 (1) ◽

pp. 19-25 ◽

Cited By ~ 2

Author(s):

Birgitta Svernlöv ◽

Jens Nestorson ◽

Lars Adolfsson

Keyword(s):

Internal Fixation ◽

Ulnar Nerve ◽

Open Reduction ◽

Open Reduction Internal Fixation ◽

Humeral Fractures ◽

Distal Humeral Fractures ◽

Nerve Dysfunction

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Intraoperative Nice knots assistance for reduction in displaced comminuted clavicle fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04348-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Fangning Hu ◽

Xi Liu ◽

Fanxiao Liu ◽

Honglei Jia ◽

Xiaolong Lv ◽

...

Keyword(s):

Blood Loss ◽

Rating Scale ◽

Clavicle Fracture ◽

Operation Time ◽

Clinical Results ◽

Intraoperative Blood Loss ◽

Traditional Group ◽

Significant Difference ◽

Clavicle Fractures ◽

Displaced Clavicle Fracture

Abstract Purpose The Nice knots have been widely used in orthopedic surgeries to fix torn soft tissue and fracture in recent years. The study aims to investigate the clinical efficacy and prognosis of intraoperative and postoperative Nice Knots-assisted reduction in the treatment of displaced comminuted clavicle fracture. Methods From Jan 2014 to Dec 2019, 75 patients diagnosed with unilateral closed displaced comminuted clavicle fracture were treated with open reduction and internal fixation (ORIF) in this study. Nice knot group (the NK group) included 38 patients and the other 37 patients were in the traditional group (the TK group). The time of operation and the amount of bleeding during operation were recorded. Post-operative clinical outcomes and radiographic results were recorded and compared between these two groups. The Visual Analogue Scale (VAS), Neer score, Rating Scale of the American Shoulder and Elbow Surgeons, Constant-Murley score and complications such as infection, nonunion, implant loosening, fragment displacement and hardware pain were observed in the two groups. Results In the comparison between the two groups, there was no significant difference in age, sex, the cause of displaced clavicle fracture, and other basic information between the two groups. The operation time, intraoperative fluoroscopy time, and intraoperative blood loss were significantly reduced in the NK group (P < 0.01). There were 2 cases of plate fracture in the TK group. The follow-up results showed that there was no significant difference in VAS, Neer score, ASES, and Constant-Murley scores between the two groups. Conclusion The use of Nice knot, in comminuted and displaced clavicle fractures can reduce intraoperative blood loss, shorten operation time, facilitate intraoperative reduction, and achieve satisfactory postoperative clinical results. This study demonstrates that Nice knot is a simple, safe, practical and effective auxiliary reduction method.

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