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

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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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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Open Reduction, Internal Fixation Distal Intraarticular Distal Humerus Fracture

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000000584 ◽

2016 ◽

Vol 30 ◽

pp. S13-S14

Author(s):

David A. Fuller

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Distal Humerus ◽

Open Reduction Internal Fixation ◽

Humerus Fracture ◽

Distal Humerus Fracture

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Comparison of outcome of closed reduction and percutaneous pinning and, open reduction and internal fixation with k-wire in Gartland extension type III supracondylar fracture of distal humerus in pediatric population

Medical Journal of Pokhara Academy of Health Sciences ◽

10.3126/mjpahs.v1i1.22449 ◽

2018 ◽

Vol 1 (1) ◽

pp. 1-3

Author(s):

Bhogendra Bahadur KC ◽

Norman Lamichhane ◽

Chandra Bahadur Mishra ◽

Bharat Bahadur Khatri ◽

Sabita Dhakal

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Closed Reduction ◽

Open Reduction ◽

Operative Procedure ◽

Distal Humerus ◽

Supracondylar Fracture ◽

P Value ◽

Percutaneous Pinning ◽

Type Iii

Background: Supracondylar fracture of the distal humerus is one of the commonest fracture in pediatric age group. Though there is consensus of treating type III fracture operatively, no study has compared the outcome between Closed Reduction and Percutaneous Pinning (CRPP) and Open Reduction and Internal Fixation (ORIF) with k-wire in our setup. Materials and Methods: Retrospective comparison study was done on eighty seven cases of Type III supracondylar fracture of distal humerus underwent operative procedure. Fifty four (54) cases underwent CRPP and 33 cases were managed with ORIF with k-wire, and they were followed up till 6 months post-operatively. Results : The mean time for radiological union in patient who underwent CRPP was 4.37±0.94 weeks and that for the patient who underwent ORIF was 4.45±0.13 weeks, the difference of which was statistically insignificant (p-value >0.05). 83.3% of CRPP group and 78.8% in ORIF group had excellent functional outcome and only 3% in ORIF group had poor functional outcome. Conclusion: Though both the group don’t have significant advantage of functional outcome among each other CRPP with limited attempt should be preferred to ORIF with k-wire for the advantage of avoiding surgical scar and reducing surgery time and exposure to anaesthetic agents.

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

10.36106/gjra/8702726 ◽

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.

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Functional outcome of elbow joint in AO type 13C fractures treated with open reduction and internal fixation using dual plates

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191793 ◽

2019 ◽

Vol 5 (3) ◽

pp. 509

Author(s):

Uyyalawada Sreedhar Reddy ◽

Bheemsingh Samorekar ◽

Vinay J. Mathew ◽

Anil Kumar Mettu

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Distal Humerus ◽

Range Of Movement ◽

Excellent Outcome ◽

Significant Difference ◽

Dual Plating ◽

Type C ◽

A Prospective Study

Background: 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.Methods: 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.Results: 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.Conclusions: 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.

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