The effect of staged surgical treatment for cubitus valgus after non-union of lateral condylar fracture of distal humerus in older children

Abstract Background: The purpose of this study was to investigate the effect of staged surgery (open reduction/internal fixation and osteotomy) for cubitus valgus after non-union of lateral condylar fractures of the distal humerus in older children.Methods: From January 2010 to January 2013, 9 patients were treated with two-staged surgery (open reduction/internal fixation and osteotomy). The study included 5 males and 4 females, with a mean age of 12.7 years. The interval from fracture to the first surgery was 8.2 years on average. All patients had symptoms of injury of the ulnar nerve and instability of the elbow. The first surgery included internal reduction, internal fixation, and bone grafting, exposing the elbow through a lateral approach. The procedure included clearing the peripheric callus and proximal distal fracture end cicatrix with rongeur until cancellous bone was exposed, and fixation of the lateral condylar fragment with a hollow screw 4.0 mm in diameter and smooth Kirschner wire. The limb was immobilized in a long arm cast with the elbow at 90 degrees of flexion and the forearm in neutral rotation for 3 weeks, and active exercises were begun after removal. The second surgery, osteotomy of the supracondylar humerus, was completed after 6 months to correct cubitus valgus. Internal fixation from the osteotomy was removed 6 months later.Results: Six months after the second surgery, follow-up revealed that in all patients the lateral condylar fractures attained clinical union and cubitus valgus was corrected. Elbow function recovered well without arthrochalasis or humeral condylar avascular necrosis. All patients’ ulnar nerve injury symptoms disappeared.Conclusion: Staged surgery to treat cubitus valgus secondary to lateral condylar fracture non-union in older children serves to first provide elbow stability, then to correct cubitus valgus. Staged treatment may make up for the deficiencies of conventional treatment. However, due to our relatively short follow-up time, the long term effects are unknown.

Download Full-text

The Effect of Staged Surgical Treatment for Cubitus Valgus After Non-Union of Lateral Condylar Fracture of Distal Humerus in Older Children

10.21203/rs.3.rs-61027/v1 ◽

2020 ◽

Author(s):

Xin Liu ◽

Li-wei Xie ◽

Zhi-qiang Deng ◽

Jia-jun Ye

Keyword(s):

Internal Fixation ◽

Distal Humerus ◽

Open Reduction Internal Fixation ◽

Older Children ◽

Cubitus Valgus ◽

Condylar Fracture ◽

Non Union ◽

Staged Surgery ◽

Condylar Fractures

Abstract Background: The purpose of this study was to investigate the effect of staged surgery (open reduction/internal fixation and osteotomy) for cubitus valgus after non-union of lateral condylar fractures of the distal humerus in older children.Methods: From January 2010 to January 2013, 9 patients were treated with two-staged surgery (open reduction/internal fixation and osteotomy). The study included 5 males and 4 females, with a mean age of 12.7 years. The minimum interval from fracture to the first surgery was 7 years and the maximum interval was 10 years (average 8.2 years). All patients had symptoms of injury of the ulnar nerve and instability of the elbow. The first surgery included internal reduction, internal fixation, and bone grafting, exposing the elbow through a Kocher lateral approach. The procedure included clearing the peripheric callus and proximal distal fracture end cicatrix with rongeur until cancellous bone was exposed, and fixation of the lateral condylar fragment with a hollow screw 4.0 mm in diameter and smooth Kirschner wire. The limb was immobilized in a long arm cast with the elbow at 90 degrees of flexion and the forearm in neutral rotation for 3 weeks, and active exercises were begun after removal. The internal fixation hardware was removed after 3 months. The second surgery, osteotomy of the supracondylar humerus, was completed after 6 months to correct cubitus valgus. Internal fixation from the osteotomy was removed 6 months later.Results: Six months after the second surgery, follow-up revealed that in all patients the lateral condylar fractures attained clinical union and cubitus valgus was corrected. Elbow function recovered well without arthrochalasis or humeral condylar avascular necrosis. All patients’ ulnar nerve injury symptoms disappeared.Conclusion: Staged surgery to treat cubitus valgus secondary to lateral condylar fracture non-union in older children serves to first provide elbow stability, then to correct cubitus valgus. Staged treatment may make up for the deficiencies of conventional treatment. However, due to our relatively short follow-up time, the long term effects are unknown.

Download Full-text

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

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03664-4 ◽

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.

Download Full-text

Temporary spanning plate across the elbow for complex fractures of the distal humerus

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04764-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ashraf N. Moharram ◽

Mostafa Mahmoud ◽

Ahmed Lymona ◽

Ahmed Afifi ◽

Mostafa Ezzat ◽

...

Keyword(s):

Bone Loss ◽

Internal Fixation ◽

Early Mobilization ◽

Distal Humerus ◽

Open Reduction Internal Fixation ◽

Dash Score ◽

Level Of Evidence ◽

The Mean ◽

Therapeutic Study

Abstract Background Open reduction internal fixation (ORIF) is the gold standard management of fractures of the distal humerus. Stable fixation to allow early mobilization is not always possible in cases with comminuted fracture patterns and bone loss, with a high failure rate. We propose augmentation of internal fixation in these unstable situations with a spanning plate across the elbow to protect the fixation construct temporarily until bone union. Methods Eighteen patients with complex distal humeral fractures were managed with standard ORIF technique augmented with a temporary plate spanning across the elbow as an internal fixator. Cases included were either very distal, comminuted (6 cases) or insufficiency fractures (4 cases) or revision fixation cases (8 cases). The temporary spanning plate was removed as soon as signs of early radiographic union were detected. Results Seventeen patients were available for final follow up at a mean 28.3 months. The spanning plate was removed after 3.4 months on average. At the final follow-up, the mean elbow total arc of motion was 86.3°. The mean Mayo Elbow Performance Score (MEPS) was 80, and the mean Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score was 27. Conclusion Spanning the elbow temporarily with a plate in adjunct to standard ORIF technique is both simple and effective in achieving fracture stability and union and minimizes failure rates after fixation of comminuted, very distal fractures, osteoporotic cases, or revision fixation cases with bone loss. Level of evidence Level IV, Therapeutic study

Download Full-text

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210620 ◽

2021 ◽

Vol 7 (2) ◽

pp. 271

Author(s):

Adarsh Krishna Bhat ◽

Tigy Thomas Jacob ◽

Shajimon Sameul

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Distal Humerus ◽

Open Reduction Internal Fixation ◽

Non Union ◽

Medical College ◽

Articular Fractures ◽

Locking Compression Plates ◽

Type C ◽

Distal Humerus Fractures

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

Download Full-text

Failure analysis and recommendations for treatment of posttraumatic non-unions of the distal humerus during childhood

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01613-3 ◽

2021 ◽

Vol 47 (2) ◽

pp. 313-324 ◽

Cited By ~ 1

Author(s):

Dirk Walther Sommerfeldt ◽

Peter Paul Schmittenbecher

Keyword(s):

Failure Analysis ◽

Revision Surgery ◽

Distal Humerus ◽

Implant Removal ◽

Supracondylar Fractures ◽

Stable Fixation ◽

Non Union ◽

Pediatric Traumatology ◽

Clinical Cases

Abstract Purpose Non-unions of the distal humerus are rare complications of common children’s fractures such as radial condyle fractures and supracondylar fractures. The aim of this paper was to update the knowledge about etiology, reasons, management, and results of these troublesome, and sometimes debilitating entities. Methods The sparse literature concerning nonunions following condylar or supracondylar fractures was analyzed together with the presentation of some typical clinical cases. Results In most of the cases, non-unions were induced by neglect, unstable fixation, too early implant removal, too much revision surgery, and an inconsequent transfer of follow-up algorithms, or combinations of the above. Treatment of non-union should start as early as possible because the effort of required surgery increases with time that the nonunion has been neglected. Often a combination of stable fixation of the pseudarthrosis and correction of the elbow axis are necessary to achieve a satisfying outcome. Conclusion In pediatric traumatology, qualified and consequent care for children’s fractures of the distal humerus can prevent rare complications such as non-unions in almost any situation. If such a disturbance of healing is noticed, immediate and adequate, i.e. children specific surgical consequences achieve best results.

Download Full-text

Complex fractures of the distal humerus in the elderly: primary total elbow arthroplasty or open reduction and internal fixation? Mid-term follow-up

International Orthopaedics ◽

10.1007/s00264-021-05027-z ◽

2021 ◽

Author(s):

Yaiza Lopiz ◽

Daniel Garríguez-Pérez ◽

Carlos García-Fernández ◽

Laura del Baño ◽

María Galán-Olleros ◽

...

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

The Elderly ◽

Distal Humerus ◽

Total Elbow Arthroplasty ◽

Elbow Arthroplasty ◽

Complex Fractures

Download Full-text

Evaluation of Factors Driving Cost Variation for Distal Humerus Open Reduction Internal Fixation

JSES International ◽

10.1016/j.jseint.2020.09.009 ◽

2020 ◽

Author(s):

Michelle Zeidan ◽

Andrew R. Stephens ◽

Chong Zhang ◽

Angela P. Presson ◽

Andrew R. Tyser ◽

...

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Distal Humerus ◽

Open Reduction Internal Fixation ◽

Cost Variation

Download Full-text

The role of open reduction and internal fixation in the treatment of the intercondylar fractures of humerus

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20193824 ◽

2019 ◽

Vol 5 (5) ◽

pp. 855

Author(s):

Venkata Sivaram G. V. ◽

Y. V. S. Prabhakar

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Early Mobilization ◽

Distal Humerus ◽

Inclusion Criteria ◽

Senior Faculty ◽

Chevron Osteotomy ◽

Stiff Elbow ◽

Condylar Fractures

Background: Inter-condylar fractures represent one of the most complicated and challenging fractures in the upper extremity. The results of managing these fractures non-operatively are limited by failure to get anatomical reduction and early mobilization, which often results in painful stiff elbow and/or pseudo-arthrosis. The objective of this study was to evaluate and analyse the role of open reduction and internal fixation in inter-condylar fractures of distal humerus.Methods: The present study was done in Malla Reddy Institute of Medical Sciences between June 2014 and June 2017. Out of 34 cases of intercondylar fractures of humerus admitted during the period, 25 patients were selected for the study that satisfied our inclusion criteria. Three patients out of those selected could not be included in the study as one had cardiac issues pre-operatively, one refused surgery and one was lost to follow up.Results: Our study included 22 patients, 14 male and 8 female patients. Their average age was 41.4 years. The fractures were classified as per the AO classification. There were B1-3, B2-1, C1-6, C2-5, C3-7 fractures. Both compound and closed fractures were included. All the patients were operated by posterior olecranon Chevron osteotomy approach by a senior faculty member. Twenty two patients who satisfied our inclusion criteria were treated, followed up and the results analyzed using Cassabaum’s scale of elbow function we had 86% of excellent to good results. Our results are comparable with other similar studies.Conclusions: Posterior olecranon approach was found to be of most satisfactory approach by us. It allows good exposure of the joint and the ulnar nerve.

Download Full-text