scholarly journals Study on functional outcome of intra articular fractures of distal humerus managed by locking compression plate

Author(s):  
Adarsh Krishna Bhat ◽  
Tigy Thomas Jacob ◽  
Shajimon Sameul

<p><strong>Background:</strong> The primary goal in management of intra articular fractures of distal humerus is to achieve stable and mobile elbow. Type C fracture of distal humerus is a relatively uncommon fracture. Internal fixation is difficult but anatomical reduction is needed to prevent poor functional outcome and degenerative changes.</p><p><strong>Methods: </strong>Functional outcome of patients who underwent open reduction internal fixation with locking compression plates for intra articular fractures of distal humerus at the department of orthopedics, Government medical college Kottayam, from December 2017 to July 2019, were assessed using Mayo elbow performance index. A total of 30 patients were studied.</p><p><strong>Results: </strong>Excellent and good results were found in 25 cases, 3 patients had fair outcome and 2 patients had poor result. Complications encountered in our study were, infection (superficial treated with antibiotics-3 cases), heterotopic ossification (3 cases), hard ware prominence (2 cases) and non-union (1 case).</p><p><strong>Conclusions: </strong>Complications were minimal and outcomes were good in patients with type C distal humerus fractures who underwent bicolumn locking compression plates fixation by posterior approach.</p><p class="abstract"> </p>

Author(s):  
Simranpreet Singh ◽  
Mudasser Arif ◽  
Sanjeev Gupta

Background: Distal humerus fractures are commonly encountered in the orthopedic emergency. The goals in the treatment of these fractures are aimed at perfect anatomical reduction which could be obtained by open reduction and internal fixation.Methods: A prospective cohort study was conducted from July 2019 to December 2020 in Government Medical College, Jammu on 35 patients with AO type C distal humerus fractures. Functional outcomes were recorded and evaluated at end of 6 months using mayo elbow performance score (MEPS) score. 3 patients were lost in the follow up and were not included in the study.Results: 32 patients in the age group 20-65 years were included in the study with a mean age of 42.5 years. Males outnumbered females in ratio of 3:1. Patients undergoing olecranon osteotomy for fixation of distal humerus fractures had mean elbow flexion (121±8.3), loss of elbow extension (10.3±4.2). The functional outcome was made using MEPS score with a mean of 84±8.4 at final follow up.Conclusions: In this study we concluded that olecranon osteotomy approach provided better outcome. Intraarticular distal humerus fractures was better visualized with olecranon osteotomy approach and allowed early mobilization.


2020 ◽  
pp. 1-3
Author(s):  
Ravindra Prasad ◽  
L B Manjhi

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.


Author(s):  
Faisal S. Mohammed ◽  
Akshay B. Ingale

<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>


Author(s):  
Amit Chandrakant Supe ◽  
Nikhil Dilip Palange ◽  
Eknath D. Pawar ◽  
Neetin P. Mahajan

<p class="abstract"><strong>Background:</strong> Extra articular distal humerus fractures are difficult to treat with conventional implants like intra medullary nail, 4.5 DCP and dual plate. The present study aims to study the functional outcome of the extra articular distal humerus plate (EADHP).</p><p class="abstract"><strong>Methods:</strong> 48 patients with displaced extra articular distal humerus fractures were included in the study. Inclusion criteria were age more than 18 years, closed fractures with or without radial nerve palsy and less than 3 weeks old trauma. Patients aged less than 18 years, those having open fractures, fractures more than 3 weeks old, non – unions and pathological fractures were excluded from the study. All patients were operated with EADHP. Clinically, the outcome was assessed by the disability of arm, shoulder and hand (DASH) score and elbow range of motion radiologically, union was evaluated on anteroposterior and lateral radiographs.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 48 patients, 12 had AO type 12 A1 fracture, 26 patients had type B1 fractures and remaining 10 had type C1 fractures. Mean DASH score at final follow up was 18.1; range being 12.6 to 35.7 points. The mean elbow range of motion was 0 to 130 degrees (range: 120 to 140 degrees). The mean duration for complete radiological fracture union was 14 weeks, range being 12 to 18 weeks.</p><p class="abstract"><strong>Conclusions:</strong> The extraarticular distal humerus plate is an ideal implant for the fixation of distal humerus fractures since it provides good stability of fracture and enables early return to function.</p>


Author(s):  
Uyyalawada Sreedhar Reddy ◽  
Bheemsingh Samorekar ◽  
Vinay J. Mathew ◽  
Anil Kumar Mettu

<p class="abstract"><strong>Background:</strong> Distal end of the humerus, with its unique orientation of articular surfaces supported by a meagre amount of cancellous bone, makes its fracture a constant challenge to orthopaedic surgeons. Aim of the study is to evaluate the functional outcome of surgical management of intercondylar AO type C fractures of distal end of humerus using dual plating.</p><p class="abstract"><strong>Methods:</strong> A prospective study was conducted at our hospital between January 2015 to December 2016. Thirty five consecutive patients with intercondylar (AO Type C) fracture of distal humerus, included in study as per inclusion criteria. All patients were treated surgically using triceps reflecting approach and posterior trans-olecranon approach with ulnar nerve exploration and fixation using dual plating and tension band wiring for olecranon osteotomy wherever done.<strong></strong></p><p class="abstract"><strong>Results:</strong> In 35 patients, final results using MEPS scoring system excellent outcome is noticed in 15 patients (42.86%), good results is noticed in 13 patients (37.14%), fair result is noticed in 5 patients (14.29%) and poor result is noticed in 2 patients (5.71%). There was statistical significant difference in flexion range of movement arc at 2 and 6 months in our study.</p><p class="abstract"><strong>Conclusions:</strong> Open reduction and internal fixation of AO type 13C fractures is challenge to surgeon, preoperative planning and mastering the technique over a period of time gives good to excellent functional outcomes.</p><p class="abstract"> </p>


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