ORIF with orthogonal plating in the management of complex distal humerus fractures -A prospective study of 30 patients

Fractures of the distal humerus are quite challenging due to the nature of the fracture. They are compounded by factors such as gross and osteoporosis, especially in the elderly age group. This study was performed to evaluate the functional outcome following ORIF (Open reduction and internal fixation) of these fractures with orthogonal plating. Thirty patients with complex fractures of the distal humerus who presented between April 2011 to April 2014 were managed with ORIF with orthogonal plating. They were followed up for three years. Functional evaluation was performed using the MEPS (Mayo elbow performance score) and the DASH score (Disabilities of arm, shoulder and hand). The right elbow was more commonly affected, as seen in 16 patients, and the most common mode of injury was road traffic accidents. The average time to fracture union was 11.6 weeks. The mean MEPS score was 88.5±11.6 with 85.6% of patients having a good or excellent outcome, and the mean DASH score was 23.2 points. ORIF with orthogonal plating of complex distal humerus fractures provides a stable fixation construct and gives good functional outcomes to the patient.

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Functional outcome of locking anatomical plate in extra articular fractures of the distal humerus

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191781 ◽

2019 ◽

Vol 5 (3) ◽

pp. 443

Author(s):

Amit Chandrakant Supe ◽

Nikhil Dilip Palange ◽

Eknath D. Pawar ◽

Neetin P. Mahajan

Keyword(s):

Range Of Motion ◽

Functional Outcome ◽

Distal Humerus ◽

Radial Nerve Palsy ◽

Dash Score ◽

Articular Fractures ◽

Early Return ◽

Humerus Fractures ◽

The Mean ◽

Distal Humerus Fractures

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

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Study of clinical outcome in intra articular distal humerus fractures treated with dual plating

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20172425 ◽

2017 ◽

Vol 5 (6) ◽

pp. 2438

Author(s):

Riyaz B. Shaik ◽

Venugopala Reddy P. ◽

Ashok Naidu K.

Keyword(s):

Clinical Outcome ◽

Road Traffic ◽

Distal Humerus ◽

Complex Nature ◽

Lateral Column ◽

Dual Plating ◽

Surgical Fixation ◽

Humerus Fractures ◽

Distal Humerus Fractures ◽

Fracture Humerus

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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Management of Distal Humerus Fractures With Jess Fixator

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v3i4.24259 ◽

2015 ◽

Vol 3 (4) ◽

pp. 16-20

Author(s):

Prakriti Raj Kandel ◽

Kishor Man Shrestha ◽

Laxmi Pathak

Keyword(s):

Distal Humerus ◽

Humerus Fracture ◽

Medical Sciences ◽

Distal Humerus Fracture ◽

Fixation Technique ◽

Fixation Techniques ◽

Humerus Fractures ◽

The Mean ◽

Distal Humerus Fractures

INTRODUCTION: Fractures of distal humerus are rare comprising approximately 2% of all fractures and a third of all humerus fractures. Even with the development of newer fixation techniques, the treatment of distal humerus fractures remains a great challenge to any orthopaedic surgeon. Thus this present study was conducted to evaluate the results of Joshi's External Stabilization System (JESS) in the management of distal humerus fracture with or without intercondylar extension. MATERIALS AND METHODS: This retrospective study was conducted by collecting records of thirty two adult patients who sustained distal humerus fracture and were managed with JESS fixation under anaesthesia over a period of two years in Universal College of Medical Sciences Teaching Hospital (UCMSTH) after obtaining permission from Institutional ethical committee. RESULTS: According to AO (Arbeitsgemeinschaft für Osteosynthesefragen) classification, 2 patients had C1 fracture and 30 patients had C2 fractures. The mean duration of JESS application was 16 weeks. The mean follow up was 8 months. The functional outcome was evaluated by using Cassebaum's functional rating system. Among C1 fractures, 50% showed fair and 50% showed good result whereas among C2 fractures, 40% showed good, 46.66% showed fair and 13.33% showed poor results. CONCLUSIONS: JESS fixation technique represents a viable option in the management of open as well as close intercondylar fractures of the distal humerus.

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Transolecranon Distal Humerus Fractures: A Mini Review

Journal of Orthopedics and Orthopedic Surgery ◽

10.29245/2767-5130/2021/1.1129 ◽

2021 ◽

Vol 2 (1) ◽

pp. 7-12

Author(s):

Shaan S. Patel ◽

Julian Gatta ◽

Adrienne Lee ◽

Blaine T. Bafus

Keyword(s):

Pediatric Patients ◽

Data Extraction ◽

Adult Population ◽

Full Range ◽

Distal Humerus ◽

Dash Score ◽

Elbow Stiffness ◽

Fractures In Children ◽

Humerus Fractures ◽

Distal Humerus Fractures

Background: Transolecranon distal humerus fractures are uncommon injuries. The purpose of this study is to review the outcomes and complications associated with transolecranon distal humerus fractures. Material and Methods: We performed a systematic search of PubMed for articles published between 1990 and 2021. Included studies reported outcomes and complications of transolecranon distal humerus fractures. Data was extracted from the included studies to describe patient demographics, injury characteristics, outcome measurements, and complications. Results: A total of 4 studies met inclusion criteria for data extraction and analysis. Two studies evaluated an adult cohort of a total of 18 patients. The average Disabilities of the Arm, Shoulder, and Hand (DASH) score was 40 (range 4.2 – 76.5). Fifteen patients (83%) had a complication. Elbow stiffness (11/18, 61%) was the most common complication. Eleven patients (61%) underwent more than one procedure. Two studies evaluated a pediatric cohort of a total of 9 patients. Five patients (56%) underwent non-operative treatment with immobilization and four patients (44%) underwent open reduction and internal fixation. There were no complications reported. All the pediatric patients regained near full range of motion of the elbow at their final follow-up. Conclusion: Transolecranon distal humerus fractures are complex elbow injuries. In the adult population, they remain a challenge for orthopaedic surgeons. Complications, including elbow stiffness and infection, are high with frequent long-term functional limitations as represented by DASH scores. In contrast, pediatric patients have good outcomes and minimal complications that are similar to isolated olecranon and distal humerus fractures in children.

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Transverse olecranon osteotomy with Gigli saw: A fast and reliable technique

10.25083/2559.5555/6.1.4 ◽

2021 ◽

Vol 6 (1) ◽

pp. 17-21

Author(s):

Bulent Karslioglu

Keyword(s):

Range Of Motion ◽

Articular Surface ◽

Distal Humerus ◽

Chevron Osteotomy ◽

Elbow Fractures ◽

Significant Difference ◽

Transverse Osteotomy ◽

Humerus Fractures ◽

The Mean ◽

Distal Humerus Fractures

Objective. Distal humerus fractures constitute of approximately 2% of all fractures and 30% of elbow fractures. Olecranon osteotomy provides excellent exposure of distal humerus and articular surface. In this study, we aimed to compare transverse osteotomy with gigli saw and classical chevron osteotomy techniques in terms of osteotomy duration and clinical results. Materials and Methods. 40 elbows of 40 patients with Type B intraarticular distal humerus fractures according to AO classification were included in our study. Patients were divided into 2 groups as transverse or chevron osteotomy groups. Patients were evaluated in terms of intraoperative osteotomy time, postoperative time to union, range of motion in the elbow joint and Quick Dash scores at 6th, 12th and 24th months. Results. The mean age of the patients was 45.6 years (19-62). 40% of the patients (8 patients) in the Chevron group had more than 2 mm stepping at articular surface, while this rate was 10% (2 patients) in the gigli saw group. Union was obtained in all patients for both techniques. There was no significant difference between the mean QuickDASH scores and range of motion of the elbow joints except flexion in both groups. Range of motion of flexion was statistically better in the gigli saw group (p<0.05). Conclusions. Transverse osteotomy technique significantly reduces osteotomy and fixation time and will not cause problems in fracture union. It may be preferred because it is simpler and faster to apply than chevron osteotomy and because intra-articular stepping is less common.

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Open reduction internal fixation with triceps-sparing approach in distal humerus fracture: an experience from a tertiary level hospital in Mangalore

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190803 ◽

2019 ◽

Vol 5 (2) ◽

pp. 345

Author(s):

Bhaskar Bhandary ◽

Sachin Shetty ◽

Mohammed Shabir Kassim ◽

Amlan Mohapatra

Keyword(s):

Internal Fixation ◽

Range Of Motion ◽

Open Reduction ◽

Final Analysis ◽

Distal Humerus ◽

Open Reduction Internal Fixation ◽

Range Of Movement ◽

Humerus Fractures ◽

The Mean ◽

Distal Humerus Fractures

Background: Fractures of the distal humerus represent challenging problems to an orthopaedic surgeon. The present study aimed to assess the range of movement after performing open reduction and internal fixation of distal humerus fractures treated with triceps sparing approach.Methods: This prospective study included all skeletally mature patients with distal humerus fractures and operated at our center with open reduction and internal fixation of distal humerus with triceps on or triceps sparing approach were included in the study. During the study period 30 cases underwent surgery and were included in the final analysis. Fractures were classified according to the AO/OTA classification. Patients will be followed up at 6 weeks, 12 weeks and at 6 months. Mean range of motion of the fractured elbow at different follow up points were compared.Results: The mean age of the total population was 37.7±13.8 years, 57% males and left side was affected in 60% of the patients. Majority of the patients had a range of motion in normal elbow in the range 0 to 140 degrees. There was an increase in the mean range of movement from 63.4±14.2 at 6th week to 120±6 at 24th week, and this change was statistically significant (p<0.001).Conclusions: Future multicentric randomized studies, specially comparing triceps-sparing with olecranon osteotomy, are needed to support the results of our study.

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A Comparative Retrospective Analysis of Tension Band Wiring and 3.5 mm Precontoured Plate Used for Fixation of Chevron Osteotomy in Type C Distal Humerus Fractures

International Journal of Recent Surgical and Medical Sciences ◽

10.1055/s-0040-1721540 ◽

2020 ◽

Vol 6 (02) ◽

pp. 53-59

Author(s):

Mayur Nayak ◽

Rahul Yadav ◽

Sahil Batra ◽

Vijay Sharma ◽

Kamran Farooque ◽

...

Keyword(s):

Wound Complication ◽

Distal Humerus ◽

Chevron Osteotomy ◽

Plate Group ◽

Loss Of Reduction ◽

Precontoured Plate ◽

Type C ◽

Humerus Fractures ◽

The Mean ◽

Distal Humerus Fractures

Abstract Introduction Complex distal humerus fractures are rare and difficult to treat and traditionally requires an open reduction and internal fixation via a transolecranon approach. However, controversy remains regarding the better method of fixation of the chevron osteotomy. The purpose of the present study was to compare the clinical efficacy of tension band wiring (TBW) and 3.5 mm precontoured plate in treating the chevron osteotomy. Materials and Methods A consecutive series of 49 patients who required olecranon osteotomy for type C distal humerus fractures were identified and grouped according to the construct used. Clinic–radiological evaluation was done at 3 months, 6 months, 1 year, and 2 years. A total of 34 males and 15 females with a mean age of 36.9 ± 12.64 years (18–62 years) were included in the study. Surgical duration, range of motion, Mayo elbow performance score (MEPS), and complications were noted at the follow-up. Results The mean range of motion was initially lower in the plate group (105 degrees ± 9.9 in plate, 107 degrees ± 9.15 in TBW) that subsequently increased at 6 months. The forearm rotation was similar in both the groups. The mean MEPS was found to be higher in the plate group at 2 years (81.83 ± 5.85 in plate, 77.76 ± 8.02 in TBW). A significantly higher rate of complications, that is, nonunion (p = 0.03), loss of reduction (p = 0.03), and revision (p = 0.04) was observed in the TBW group. However, other complications such as symptomatic hardware, wound complication, and removal of hardware were found to be higher in the plate group. Conclusion Both TBW and 3.5 mm precontoured plate provide comparable functional outcomes; however, the complication rate in terms of nonunion, loss of reduction, and revision is seen in the TBW, whereas wound complication and symptomatic hardware are more commonly seen in the plate.

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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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