Dual Plating Osteosynthesis Technique used for Fixation of Inter - Condylar Distal Humerus Fractures via Transolecranon Approach

Background: In adults, distal humerus fractures are uncommon and intra-articular, oftenly involve both the medial and lateral columns. Open reduction and surgical fixation with plating gives good results. The aim of this study is to evaluate clinical outcome in intra articular distal humerus fractures treated with dual plating.Methods: This is a prospective type of study of 20 cases of supra condylar fracture humerus with inter condylar extension treated surgically with dual plating one on the medial boarder and another on posterior surface of lateral column using standard dorsal approach, olecranon osteotomy.Results: The range of age was between 18-52 years, with mean age of 32.55 years. The maximum incidence was between 18 to 40 years i.e. 16 cases (80%). With road traffic accident (RTA) as major cause of injury. Most of the patients were males 14 (70%) with right upper limb was involved in 12 (60%) cases. According to MEP score clinical outcome was excellent in 4(20%) good in 10(50%) fair in 5(25%) and poor in one (10%).Conclusions: Distal humerus fractures are known for their complex nature and technical difficult in surgical management. Proper anatomical articular reconstruction and stable fixation helps in restoring painless and functional elbow.

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Intra-articular Distal Humerus Fractures: Parallel Versus Orthogonal Plating

HSS Journal ® ◽

10.1177/15563316211009810 ◽

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.

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Functional Outcome of Intercondylar Distal Humerus Fractures Surgically Treated with Open Reduction and Internal Fixation with a Principle Based on Orthogonal Plating Technique

Birat Journal of Health Sciences ◽

10.3126/bjhs.v6i1.37625 ◽

2021 ◽

Vol 6 (1) ◽

pp. 1336-1340

Author(s):

Santosh Thapa ◽

Ranjib Kumar Jha ◽

Ashish Rajthala

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Distal Humerus ◽

Plating Technique ◽

Significant Difference ◽

Dual Plating ◽

Humerus Fractures ◽

Distal Humerus Fractures ◽

One Year

Introduction: Owing to the complex articular structure, paucity of metaphyseal bone and thin soft tissue covering, treatment of intra-articular distal humerus fractures still pose challenge to surgeons. Although it comprises 2% of all fractures the massive complication rate to the treatment is worrisome. This study aims to evaluate the outcome of surgical treatment of these fractures by open reduction and internal fixation by dual orthogonal plates. Objectives: The objective of the study is to evaluate the functional outcome of intercondylar humerus fractures managed with open reduction and internal fixation with orthogonal dual plating technique. Methodology: Eighteen patients (19 – 68 years old) with AO/OTA type 13C fractures were evaluated after surgery for one year with MEPS and range of motion. Complications were categorized as major or minor complications. Functional comparisons were made between simple articular type C1/C2 and complex articular type C3 fractures at one year. Result: There were 2 (11.11%) type C1 fracture and 8 (44.44%) each in type C2 and C3 fractures. Eight (44.44%) patients obtained excellent, 7 (38.89%) obtained good and 3 (16.7%) obtained fair results. There was no poor outcome. Average MEPS score was 83.33 and there was no significant between the subgroups (p = 0.07). The average flexion was 118.06° and it was significantly impaired in type C3 fractures (p = 0.03). Three patients obtained full extension, and remaining patients had mean extension deficit of 12°. Average arch of motion was 108.06° with significant difference between two subgroups (p = 0.008). The mean arc of motion for supination-pronation was 154.44°. There was 5 minor and 2 major complications (total - 38.9%). Conclusion: The surgical management with open reduction and internal fixation by dual plates in orthogonal configuration for the intercondylar distal humeral AO type C fractures has good or excellent functional outcome in majority of the patients.

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Ulnar Nerve Injury Caused by the Incomplete Insertion of a Screw Head after Internal Fixation with Dual Locking Plates in AO/OTA Type C2 Distal Humerus Fractures

Clinics in Shoulder and Elbow ◽

10.5397/cise.2017.20.4.236 ◽

2017 ◽

Vol 20 (4) ◽

pp. 236-239

Author(s):

Jae Hyuk Shin ◽

Whan Jin Kwon ◽

Yoon Suk Hyun

Keyword(s):

Nerve Injury ◽

Ulnar Nerve ◽

Distal Humerus ◽

Screw Head ◽

Anterior Transposition ◽

Intraarticular Fractures ◽

Dual Plating ◽

Humerus Fractures ◽

Ulnar Nerve Injury ◽

Distal Humerus Fractures

After dual plating with a locking compression plate for comminuted intraarticular fractures of the distal humerus, the incidence of ulnar nerve injury after surgery has been reported to be up to 38%. This can be reduced by an anterior transposition of the ulnar nerve but some surgeons believe that extensive handling of the nerve with transposition can increase the risk of an ulnar nerve dysfunction. This paper reports ulnar nerve injuries caused by the incomplete insertion of a screw head in dual plating without an anterior ulnar nerve transposition for AO/OTA type C2 distal humerus fractures. When an anatomical locking plate is applied to a distal humeral fracture, locking screws around the ulnar nerve should be inserted fully without protrusion of the screw because an incompletely inserted screw can cause irritation or injury to the ulnar nerve because the screw head in the locking system usually has a slightly sharp edge because screw head has threads. If the change in insertion angle and resulting protruded head of the screw are unavoidable for firm fixation of fracture, the anterior transposition of the ulnar nerve is recommended over a soft tissue shield.

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Open or Closed Pinning for Distal Humerus Fractures in Children?

Swiss Surgery ◽

10.1024/1023-9332.9.2.76 ◽

2003 ◽

Vol 9 (2) ◽

pp. 76-81 ◽

Cited By ~ 12

Author(s):

de Buys Roessingh ◽

Reinberg

Keyword(s):

Distal Humerus ◽

Neurological Involvement ◽

Cubitus Varus ◽

Cubitus Valgus ◽

Fractures In Children ◽

Motor Deficiency ◽

Humerus Fractures ◽

Distal Humerus Fractures ◽

With Screws ◽

Length Of Hospitalization

Introduction: In children, the choice between percutaneous pinning (PP) and open pinning fixation (OPF) for the surgical treatment of fractures of the distal humerus remains controversial, especially the PP method for internal humeral condylar (IHC) fractures. Patients and methods: Eighty fractures of the distal humerus in children were treated surgically in our hospital over a ten year period. 47% (n = 38) were supracondylar (SC), 20% (n = 16) comminuted (COM), 18% (n = 14) internal humeral condylar (IHC), and 15% (n = 12) lateral humeral condylar (LHC). We used PP, OPF and three times osteosynthesis with screws. Results: In comparison to OPF, PP reduced the length of hospitalization in SC fractures (2.8 versus 6.1 days) and IHC fractures (2.4 versus five days). It reduced the risk of extension deficiency (11.1% versus 15%) and of cubitus valgus (0% versus 20%) in SC fractures, and of cubitus varus in IHC fractures (0% versus 11.1%). However it induced a higher rate of cubitus valgus (11.1% versus 20%) in IHC fractures, one persistent neurological motor deficiency (radial nerve) and four cases of transitional neurological involvement (ulnar nerve). Conclusions: PP is a good surgical method for SC and for also for IHC fractures, if performed by experienced surgeons so as to avoid neurological damage.

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