Outcome of Dual 90-90 Plating in Intercondylar Fractures of Distal Humerus in Adults

Background: Intercondylar fracture of distal humerus are very difficult to manage. It needs proper anatomic reconstruction and rigid fixation. Aims and Objectives of study: Evaluation of outcome of dual bicolumnar 90-90 plating of AO type 13C fractures of distalhumerus in adult. Material and method: In a prospective hospital based study on 16 patients with a mean age of 33.37 years ± SD8.30, who presented with intercondylar fracture of distal hummers were studied between July 2015 to December 2017. All patients were graded according to AO classification. Out of 16 patients 5 were in 13C1, 6 were in 13C2 and 5 were in 13C3 subgroup. All patients underwent open reduction through Chevron olecranon osteotomy and fixation was done with dual plating in 90-90 fashioni.e.; 3.5 reconstruction plate posterior and 1/3 tubular plate from medial border. We used the Mayo elbow performance score system for evaluating our results. Results: The mean follow up period was 9.38 months. All fractures healed uneventfully. Two of five patients with 13C3 fractures and two of six patients with 13C2 fractures has flexion deformity of less than 30*. Average range of motion was 95*(range 60*-130*). The Mayo elbow performance score was excellent in 7, good in 7 and fair in 2 patients. Conclusion: Dual 90-90 plating technique through Chevron olecranon osteotomy is a good method for intercondylar reconstruction with rigid fixation like AO 13C fractures.

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Evaluation of functional outcome after osteosynthesis of intra articular distal humerus fracture with pre contoured locking compression plates

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20204587 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1215

Author(s):

Faisal S. Mohammed ◽

Akshay B. Ingale

Keyword(s):

Functional Outcome ◽

Distal Humerus ◽

Distal Humerus Fracture ◽

Performance Score ◽

Mayo Elbow Performance Score ◽

Locking Compression Plates ◽

Humerus Fractures ◽

Distal Humerus Fractures ◽

Extensor Lag

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

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THE TREATMENT OF EXTRA- AND INTRA-ARTICULAR FRACTURES THE DISTAL HUMERUS

Traumatology and Orthopedics of Russia ◽

10.21823/2311-2905-2010-0-3-144-151 ◽

2010 ◽

Vol 16 (3) ◽

pp. 96-102

Author(s):

V. V. Klyuchevsky ◽

Hassan Ben El Hafi

Keyword(s):

Soft Tissues ◽

Functional Results ◽

Distal Humerus ◽

Distal Segment ◽

Rigid Fixation ◽

Performance Score ◽

Mayo Elbow Performance Score ◽

Articular Fractures ◽

Active Mobilization ◽

Violent Acts

From 2005 to 2009 we treated 112 patients with fractures of distal segment of the humerus, 83 (74,10%) of them were injured when falling from the height of its own growth, 8 (7,14%) - in an accident, 6 (5,35%) - a fall from a height, 13 (11,6%) - in sports, and two - as a result of violent acts. In 97 (87%) cases the fractures were closed, in 15 (13%) - open. 19 patients were treated conservatively and 93 - operatively. Functional results were evaluated using the Mayo elbow performance score (MEPS) in 78,37% of patients. Results of the conservative method: excellent and good - 46,66%, and in all patients with type A without displacement - in 100%. The fair results - in 33% and the poor in 20% - with type В and C. The results of operative treatment: excellent and good - 90,41%, the fair results - in 9,58%, no poor results. Initial prevent the oedema and bleeding into joints and soft tissues, adequate rigid fixation of fractures with the maximal restoration of the elbow joint congruent without additional immobilization and early active mobilization is essential to prevent the elbow stiffness and achieve a good outcomes.

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Treatment of terrible triad injuries at a mean follow-up of nine years

Shoulder & Elbow ◽

10.1177/1758573218809375 ◽

2018 ◽

Vol 11 (6) ◽

pp. 450-458 ◽

Cited By ~ 2

Author(s):

Ezequiel E Zaidenberg ◽

Mariano O Abrego ◽

Agustin G Donndorff ◽

Jorge G Boretto ◽

Pablo De Carli ◽

...

Keyword(s):

Terrible Triad ◽

Performance Score ◽

Level Of Evidence ◽

Mayo Elbow Performance Score ◽

Flexion Extension ◽

Long Term Follow Up ◽

Radiological Changes ◽

One Year

Background To evaluate the sustainability of the early clinical and radiological outcomes of terrible triad injuries at long-term follow-up. Methods Twelve consecutive patients who underwent fixation of terrible triad injuries with minimum of seven years of follow-up. Functional and radiological outcomes at one year and final follow-up were compared. We assessed Mayo Elbow Performance Score, Quick-Disability of the Arm Shoulder and Hand, and modified-American Shoulder and Elbow Surgeons Scores. Radiological evaluation included Broberg and Morrey classification and Hastings classification for heterotopic ossification. Results The mean age of patients was 55 years, with a median follow-up of 9.3 years. At final evaluation, mean flexion, extension, supination, and pronation were 145°, 6°, 82°, and 80°, respectively; mean Mayo Elbow Performance Score, modified-American Shoulder and Elbow Surgeons Scores, and Quick-Disability of the Arm Shoulder and Hand scores were, respectively, 97, 92, and 4.9 points. There was no statistical difference between early and final follow-up range of motion, Mayo Elbow Performance Score, and Quick-Disability of the Arm Shoulder and Hand. However, radiological changes were observed in 66% of the patients at final follow-up. Two patients underwent reoperation, with final satisfactory results. Conclusion Our results suggested that using a standardized protocol, satisfactory clinical outcomes at early follow-up could be maintained over time. However, early complications and osteoarthritic changes at long-term follow-up can be expected. Level of evidence Therapeutic IV Cases series.

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Monteggia-like lesions in adults treated with radial head arthroplasty—mid-term follow-up of 27 cases

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1540-z ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Matthias Jung ◽

Corinna Groetzner-Schmidt ◽

Felix Porschke ◽

Paul A. Grützner ◽

Thorsten Guehring ◽

...

Keyword(s):

Radial Head ◽

Radial Head Fracture ◽

Dash Score ◽

Performance Score ◽

Analog Scale ◽

Mayo Elbow Performance Score ◽

Radial Head Arthroplasty ◽

Radial Head Replacement ◽

The Mean

Abstract Background The aim of the study was to analyze the functional and radiological outcome of Monteggia-like lesions in adults with unreconstructible fracture of the radial head and treatment with radial head arthroplasty. Methods Twenty-seven patients (mean age 56 years; range 36 to 79 years) with a Monteggia-like lesion and treatment with radial head replacement were included in this retrospective study. Minimum follow-up was 2 years. Clinical assessment included the pain level with the visual analog scale in rest (VASR) and under pressure (VASP), range of motion, Mayo Elbow Performance Score (MEPS), and Disability of the Arm, Shoulder, and Hand score (DASH). A detailed radiological evaluation was performed. Complications and revisions were also analyzed. Results After a mean follow-up period of 69 months (range, 24 to 170) the mean DASH score was 30 ± 24, the MEPS averaged 77 ± 20 points, the mean VASR was 2.1 ± 2.4, and VASP was 4.5 ± 3.5. Mean loss of extension was 24° ± 18 and flexion was 124° ± 20. Heterotopic ossifications were noted in 12 patients (44%). A total of 17 complications were noted in 11 patients (41%), leading to 15 revision surgeries in 9 patients (33%). Patients with a complicated postoperative course showed a worse clinical outcome compared with patients without complications measured by MEPS (68 ± 22 vs. 84 ± 16), DASH (49 ± 16 vs. 20 ± 22) and ulnohumeral motion (77° ± 31 vs. 117° ± 23). Conclusions Monteggia-like lesions with unreconstructible radial head fracture and treatment with radial head replacement are prone to complications and revisions.

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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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SEMI-CONSTRAINED TOTAL ELBOW ARTHROPLASTY IN CHINESE RHEUMATOID PATIENTS

Hand Surgery ◽

10.1142/s0218810403001649 ◽

2003 ◽

Vol 08 (02) ◽

pp. 187-192 ◽

Cited By ~ 8

Author(s):

C. Y. Lo ◽

K. B. Lee ◽

C. K. Wong ◽

Y. P. Chang

Keyword(s):

Bone Graft ◽

Deep Infection ◽

Total Elbow Arthroplasty ◽

Radiological Sign ◽

Performance Score ◽

Early Complications ◽

Mayo Elbow Performance Score ◽

Elbow Arthroplasty

Seventeen Coonrad-Morrey semi-constrained total elbow replacements were performed on 14 Chinese rheumatoid patients. The elbows were reviewed retrospectively after a mean follow-up of 36 months (range 12–89 months.) After the operation, all patients were satisfied and there was no pain in 15 elbows. There was no radiological sign of loosening in the implanted prostheses and bone graft was incorporated in 93% of primary elbow replacements. The Mayo Elbow Performance Score was improved from an average of 40 (range 20–75) to an average of 93 (range 65–100). The arc of flexion was improved from an average of 89° (range 0°–125°) to 104° (range 35°–125°). The sizes of implants can be predicted accurately by the planning template in only four elbows (24%) and there were early complications in seven elbows (41%), with one prosthesis removed because of deep infection.

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Clinical Results of Arthroscopic Treatment for Lateral Epicondylitis of Elbow

Clinics in Shoulder and Elbow ◽

10.5397/cise.2011.14.2.187 ◽

1970 ◽

Vol 14 (2) ◽

pp. 187-192 ◽

Cited By ~ 1

Author(s):

Jin Young Park ◽

Jeong Woo Kim ◽

Churl Hong Chun ◽

Hong Je Kang ◽

Jong Yun Kim ◽

...

Keyword(s):

Conservative Treatment ◽

Lateral Epicondylitis ◽

Clinical Results ◽

Loose Body ◽

Arthroscopic Debridement ◽

Performance Score ◽

Analog Scale ◽

Mayo Elbow Performance Score ◽

The Mean

PURPOSE: The purpose of this study was to evaluate the clinical result of arthroscopic debridement with treatment of associated intra-articular lesions in lateral epicondylitis patients who did not response to conservative treatment.METHOD: Between March 2005 and January 2010, 43 patients who were diagnosed with lateral epicondylitis and did not response to conservative treatment over 6 months were selected. The mean age of the patients was 51 years (39~68 years) and the mean follow up period was 36.7 months (18~72 months). Among the 43 patients, 15 were male and 28 were female. They were evaluated by visual analog scale (VAS) and Mayo Elbow Performance Score (MEPS).RESULTS: Intra-articular synovitis was found in 11 cases (26%) and intra-articular loose body was observed in 2 cases. The average VAS score was 7(+/-0.7) preoperatively and decreased to 1(+/-1.0) at last follow up. MEPS was 45(+/-10.2) preoperatively and increased to 93(+/-10.0). At last follow up, 41 of the 43 patients showed satisfaction (MEPS <75) and 2 showed dissatisfaction (MEPS > or =75).CONCLUSION: There was a better outcome at 18 months follow up after arthroscopic debridement with treatment of associated intra-articular lesion in lateral epicondylitis patients who had not responsed to conservative treatment.

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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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PREVENTION OF INSTABILITY OF THE PROXIMAL END OF THE RADIUS AFTER RADIAL HEAD RESECTION USING AN ANCONEUS MUSCLE FLAP

Hand Surgery ◽

10.1142/s0218810412500049 ◽

2012 ◽

Vol 17 (01) ◽

pp. 25-31 ◽

Cited By ~ 7

Author(s):

Kinya Nishida ◽

Norimasa Iwasaki ◽

Tadanao Funakoshi ◽

Makoto Motomiya ◽

Akio Minami

Keyword(s):

Radial Head ◽

Muscle Flap ◽

Performance Score ◽

Radiographic Findings ◽

Mayo Elbow Performance Score ◽

Proximal Radius ◽

Radial Head Resection ◽

The Mean ◽

Stabilization Technique

Resection of the radial head frequently causes instability of the proximal end of the radius. To prevent this instability, we performed a stabilization technique using an anconeus muscle flap. Since 2003, six patients with radiocapitellar joint dysfunction have been treated with radial head resection combined with stabilizing its proximal end using an anconeus muscle flap. At a mean follow-up of 51 months, all patients were free from elbow pain and the mean Mayo Elbow Performance Score and the Disabilities of the Arm, Shoulder and Hand score significantly improved. Radiographic findings showed no apparent instability of the proximal radius. The anconeus is useful as a reliable muscle flap for preventing instability of the proximal radius after a radial head resection. This procedure does not require any microvascular techniques and makes it possible to apply a pedicled muscle flap using a relatively simple technique without any considerable risks of elbow dysfunction.

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A study of functional outcome after osteosynthesis of intercondylar fracture of distal humerus in adults with pre-contoured locking compression plate system

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20194814 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1107

Author(s):

Ankur Ojha ◽

Shashi Kant Kumar Singh

Keyword(s):

Functional Outcome ◽

Distal Humerus ◽

High Rate ◽

Humerus Fracture ◽

Time Interval ◽

Distal Humerus Fracture ◽

Ulnar Nerve Palsy ◽

Dual Plating ◽

Plate System

Background: Intra-articular fracture of distal humerus is considerable cause of morbidity in adults. The new pre-contoured LCP system provides better angular stability in fixation of inter-condylar distal humerus fracture.Methods: A prospective study of 25 patients with distal humerus fracture treated with pre-contoured double plate system is conducted in Department of Orthopaedics, RIMS, Ranchi between April 2017 to March 2018. These patients were followed up 3 weekly in first 3 months, then 6 weekly in next 6 months, then at every 3 month interval. Clinical and functional outcome was evaluated on the basis of Mayo elbow performance score (MEPS).Results: 24 fixed elbows were reviewed at a follow-up period of 1 year. Results obtained were graded on the basis of MEPS, 21 patients (87.5%) were graded excellent to good, fair in 2 patients (8.3%) and poor in 1 case (4.1%). Average time interval between surgery and admission was 9 days (average 4-14 days). All the fractures as well as the olecranon osteotomies united by 10-16 weeks (12.56 weeks). Superficial wound infection and transient ulnar nerve palsy was reported in 3 (12.5%) and 1 (4.16%) respectively and was managed conservatively. 1 patients did not reported in follow up.Conclusions: We conclude that osteosynthesis with pre contoured dual plating of closed intracondylar distal humerus fractures provide good fixation and early rehabilitation, leading to high rate of bone union and minimal soft tissue damage.

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