Management of Distal Humerus Fractures With Jess Fixator

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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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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Primary Total Elbow Replacement for Treatment of Complex Distal Humerus Fracture: Outcomes of Short-term Follow-up

Clinics in Shoulder and Elbow ◽

10.5397/cise.2020.00045 ◽

2020 ◽

Vol 23 (1) ◽

pp. 20-26

Author(s):

Du-Han Kim ◽

Beom-Soo Kim ◽

Chung-Sin Baek ◽

Chul-Hyun Cho

Keyword(s):

Distal Humerus ◽

Humerus Fracture ◽

Distal Humerus Fracture ◽

Short Term ◽

Total Elbow Replacement ◽

Humerus Fractures ◽

Elbow Replacement ◽

Distal Humerus Fractures ◽

Quick Dash

Background: High complication rate after open reduction and internal fixation can lead to use of primary total elbow replacement (TER) in treatment of complex distal humerus fractures in elderly patients. The purpose of this study was to investigate the short-term outcomes and complications after primary TER in patients with complex distal humerus fracture. Methods: Nine patients with acute complex distal humerus fracture were treated by primary TER using the semiconstrained Coonrad-Morrey prosthesis. The mean age of patients was 72.7 years (range, 63–85 years). Clinical and radiographic outcomes were evaluated over a mean follow-up of 29.0 months (range, 12–65 months) using visual analog scale (VAS) score for pain; Mayo elbow performance score (MEPS); Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score; and serial plain radiographs. Complications were also evaluated. Results: At the final follow-up, mean VAS, MEPS, and Quick-DASH scores were 1.2, 80.5, and 20, respectively. The mean range of motion was 127.7o of flexion, 13.8o of extension, 73.3o of pronation, and 74.4o of supination. There was no evidence of bushing wear or high-grade implant loosening on serial plain radiographs. Three complications (33.3%) comprising two periprosthetic fractures and one ulnar neuropathy were observed.Conclusions: Primary TER for treatment of complex distal humerus fractures in elderly patients yielded satisfactory short-term outcomes. However, surgeons should consider the high complication rate after primary TER.

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FUNCTIONAL OUTCOME OF DISTAL HUMERUS FRACTURE BY PARATRICEPITAL TWO WINDOW APPROACH

10.36106/ijsr/6516805 ◽

2021 ◽

pp. 57-58

Author(s):

Chhatrapal Singh ◽

R.S. Bajoria ◽

Arvind ambedkar ◽

Sourabh Alawa

Keyword(s):

Soft Tissue ◽

Functional Outcome ◽

Distal Humerus ◽

Humerus Fracture ◽

Distal Humerus Fracture ◽

Excellent Functional Outcome ◽

Humerus Fractures ◽

Distal Humerus Fractures ◽

Window Approach

Background-Most of distal humerus fractures are dealt with olecranon osteotomy approach which stand as cumbersome process resulting in excessive soft tissue damage and excess hardware interposition. Alternate paratricepital two window approach has been advocated by many authors as better approach to deal with AO type A, B, and C1 type distal humerus fractures. AIM -To evaluate functional outcome of distal humerus fracture xation through paratricepital two window approach Materials & Methods – A complete of 30 patients of closed fracture distal humerus fracture underwent open fracture xation through paratricepital approach. Average age of patient was 35yr .Regular follow up and physiotherapy sessions were carried out. Average period of follow up was 12 month. Results – Out of 30 patients 28 were nally followed up till 1 year, one patient died in between while another one undergoes implant removal due to infection. From 28, 20 patients has excellent functional outcome, 3 has good, 4 has fair outcome and one patient has poor results in terms of MEPS and DASH score. Conclusion – Based on present study and data analysis we conclude that distal humerus fracture treated through paratricepital two window approach results in excellent functional outcome which is evident from ability to early start various day to day to day activities like performing st nd personal hygiene, combing hairs ,putting shirt- shoes themselves and starts eating themselves by 1 or 2 week of surgery .Unlike traditional approach like Olecranon osteotomy , it maintains adequate Tricep extensor mechanism ,does minimal soft tissue damage ,minimal post op pain ,promote early wound healing and avoid excessive hardware transposition

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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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Functional outcome evaluation of distal humerus fracture fixation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201017 ◽

2020 ◽

Vol 6 (3) ◽

pp. 467

Author(s):

Boddu Sunil ◽

Sandeep Krishna Avulapati ◽

Suraj Kumar Choudhary ◽

Susmitha Koneru

Keyword(s):

Functional Outcome ◽

Locking Plate ◽

Distal Humerus ◽

Outcome Evaluation ◽

Humerus Fracture ◽

Treatment Modalities ◽

Research Centre ◽

Distal Humerus Fracture ◽

Humerus Fractures ◽

Distal Humerus Fractures

Background: Distal humerus fracture are complex, difficult to reduce and fix, cumbersome post-operative mobilization, and yet functional outcome is doubtful. Though various treatment modalities available for past many decades ranging from conservative management, K wire fixation to plate and screws, but still treatment remains difficult. The objective of the study was to assess functional outcome of operative fixation of distal humerus with locking plate and screws.Methods: Prospective study was done in during November 2015 to June 2016 in Vydehi Institute of Medical Sciences and Research Centre, Bengaluru. Patients with distal humerus fractures who were admitted into hospital for operative treatment after fulfilling inclusion and exclusion criteria were included into study. They were followed up to 6 months post-operatively. Functional outcome evaluation was done with Mayo’s elbow performance score.Results: 30 patients were included into study with full data. We had excellent, good, fair and poor outcome in 17, 8, 3, 2 patients respectively. Except for infection in one, elbow stiffness in two and non-union in two patients, we had no other complications.Conclusions: Management of distal humerus fractures with preoperative evaluation, pre-operative planning, use of locking plate and screws, early mobilization can result in good functional outcome.

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A Limited Fixation, Olecranon Sparing Approach, for Management of Geriatric Intra-Articular Distal Humerus Fractures

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320950063 ◽

2020 ◽

Vol 11 ◽

pp. 215145932095006

Author(s):

Philip B. Kaiser ◽

Erik T. Newman ◽

Christopher Haggerty ◽

Paul T. Appleton ◽

John J. Wixted ◽

...

Keyword(s):

Elderly Patients ◽

Distal Humerus ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Additional Surgery ◽

Patient Reported ◽

Functional Scores ◽

Humerus Fractures ◽

Distal Humerus Fractures

Purpose: We propose that geriatric comminuted intra-articular distal humerus fractures can be effectively treated with a limited fixation approach aimed at achieving varus/valgus stability with columnar fixation, but allowing intra-articular comminution to heal by secondary congruency against an intact olecranon, thus avoiding an olecranon osteotomy. Methods: Fifty-six elderly patients with AO 13-C type fractures, who underwent surgical fixation with ≥12-months of follow-up were retrospectively reviewed. Thirty patients were treated with intra-articular open reduction internal fixation (ORIF) with an olecranon osteotomy and 26 patients were treated with our limited fixation (L-ORIF) approach. Outcomes were range of motion (ROM), complications, additional surgery, and patient-reported outcome measures (PROMIS). Results: At final follow-up, the average elbow ROM was 97° (40°-155°) in the ORIF group and 86.5° (20°-145°) in the L-ORIF group. There was a trend toward more complications and additional surgery in the ORIF group. PROMIS scores for pain were 53.1 and 52.14, and PROMIS functional scores were 41.7 and 41.4 in the ORIF and L-ORIF group respectively. No differences in outcomes were statistically significant. Conclusion: A limited fixation technique based on achieving varus/valgus stability with columnar fixation, demonstrated equivalent outcomes in elderly patients with intra-articular distal humerus fractures when compared to intra-articular ORIF with an olecranon osteotomy

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Low Extra-articular (Transcondylar) Fractures of the Distal Humerus

Shoulder & Elbow ◽

10.1111/j.1758-5740.2012.00203.x ◽

2012 ◽

Vol 4 (4) ◽

pp. 282-286

Author(s):

Alexander A. Weening ◽

Kim M. Brouwer ◽

Margaritha Adams ◽

David Ring

Keyword(s):

Medical Record ◽

Distal Humerus ◽

Common Type ◽

Fracture Type ◽

Non Union ◽

Results Of Treatment ◽

Humerus Fractures ◽

Distal Humerus Fractures ◽

And Function

Background We reviewed our experience with low transcondylar, extra-articular distal humerus fractures to determine the prevalence of extra-articular distal humerus fractures, the percentage that are low transcondylar fractures, and the results of treatment. Material and methods One hundred seventy-four fractures of the distal humerus in adult patients were identified. Patients with at least 1-year of follow-up were evaluated based on the medical record according to the system described by Broberg and Morrey. Results Twenty-six fractures (15%) were extra-articular (AO Type A), 15 involved both the medial and lateral columns (8.6%), nine of which were low transcondylar fractures representing 5% of all fractures and 60% of the extra-articular bicolumnar fractures. Among the nine patients with low transcondylar fractures, two had non-union and three died within 3 months of injury. Among the eight patients with healed fractures after sufficient follow-up, patients with higher extra-articular distal humerus fractures had better motion and function than patients with low transcondylar fractures. Conclusions Transcondylar fractures are the most common type of extra-articular bicolumnar fracture and may be more common than previously recognized. Mortality within 3 months and non-union appear common with this fracture type.

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Elbow Posterolateral Rotatory Instability due to Cubitus Varus and Overuse

Case Reports in Orthopedics ◽

10.1155/2018/1491540 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Juan Martín Patiño ◽

Alejandro Rullan Corna ◽

Alejandro Michelini ◽

Ignacio Abdon ◽

Alejandro José Ramos Vertiz

Keyword(s):

Tennis Elbow ◽

Distal Humerus ◽

Cubitus Varus ◽

Rotatory Instability ◽

Posterolateral Rotatory Instability ◽

Humerus Fractures ◽

Distal Humerus Fractures

A malunion as a complication of distal humerus fractures has been frequently linked with aesthetic problems but less frequently with posterolateral rotatory instability. We report 2 cases of childhood posttraumatic cubitus varus with subsequent posterolateral rotatory instability and their treatment with a minimum of 2 years of follow-up. The etiology of the so-called posterolateral rotatory instability of the elbow is mostly traumatic, but iatrogenic causes have also been described such as the treatment of tennis elbow and less frequently and chronically due to overuse and overload because of distal humerus malunion.

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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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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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