OUTCOMES IN DOUBLE TENSION BAND OSTEOSYNTHESIS IN DISTAL HUMERUS FRACTURES AO TYPE C1

2021 ◽  
pp. 208-210
Author(s):  
Sanjay V. Popere ◽  
Mohit R. Shete ◽  
Siddharth S. Vakil ◽  
Abhay Kulkarni ◽  
Karan Pandav
Keyword(s):  
Distal Humerus ◽  
Fracture Site ◽  
Tension Band ◽  
Hardware Removal ◽  
Humeral Fractures ◽  
Effective Technique ◽  
Tourniquet Time ◽  
Mean Values ◽  
Distal Humeral Fractures ◽  
The Mean

Introduction: Distal humeral fractures accounts for approximately 2% of all fractures and nearly onethird of humeral fractures in adults. In this regard, Double Tension Band Wiring (DTBW) technique was used for the xation of the distal humeral fractures type C1 (AO) to evaluate the early movement and complications of the patients. Methodology: This study was conducted on 38 patients of C1 (AO type)who were subjected to open reduction and internal xation using DTBW techniques, to evaluate the incidence of complications and to evaluate intraoperative parameters and postoperative functional outcomes over a period of 12 months. Results: The mean age of the participants was 43.7 years. The mean tourniquet time was 76 minutes. The mean union time was 11.4 weeks and the mean duration of the follow-ups was 13.72 months. The mean values for the lack of extension, exion, and range of motion were 12.24o, 120.9o, and 108.2o respectively. Neuropraxia was observed in 1 patient who was treated with conservative treatment. Mean MEPS score was 80.15. 17 patients had excellent scores , 12 had good scores and 9 had fair scores. None had poor scores. Hardware prominence was observed in 1 case which was treated with hardware removal after union was achieved. Hardware removal was performed 6 months after the surgery. Moreover, patients were diagnosed with no serious complications, such as the nonunion of fracture site, malunions, and deep infection. The radiological examination of the patients revealed the success of their treatment. Conclusions: Based on the obtained results, it can be concluded that DTBW is an effective technique in AO type C1 fracture xation, which allows gentle early motion. Moreover, this cost-effective technique decreased the surgery duration, tourniquet time, and damage caused by soft tissue stripping.

scholarly journals Coronal shear fractures of the distal humerus: Current concepts and surgical techniques

2019 ◽  
Vol 12 (2) ◽  
pp. 124-135 ◽  
Author(s):  
Jay J Watson ◽  
Simon Bellringer ◽  
Joideep Phadnis
Keyword(s):  
Clinical Experience ◽  
Surgical Techniques ◽  
Distal Humerus ◽  
Humeral Fractures ◽  
Articular Fractures ◽  
Distal Humeral Fractures

Coronal shear fractures of the distal humerus are a unique subset of distal humeral fractures which entail partial or complete articular fractures of the distal humerus without involvement of the columns. The very distal nature of these fragments, their small size and propensity for comminution render them challenging to treat surgically. The purpose of this article is to describe the classification, outcomes and surgical techniques currently used for the treatment of these fractures using the available literature and authors' clinical experience.

scholarly journals INTERNAL FIXATION OF TYPE I CAPITELLUM FRACTURE WITH HEADLESS SCREWS: A CASE REPORT

2021 ◽  
Vol 10 (2) ◽  
pp. 70
Author(s):  
Charlie Sanjaya ◽  
I Ketut Gede Arta Bujangga
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Fracture Site ◽  
Humeral Fractures ◽  
Anatomical Reconstruction ◽  
Type I ◽  
Rigid Fixation ◽  
Distal Humeral Fractures ◽  
Capitellum Fracture

Background: Capitellum fractures are relatively rare. Distal humeral fractures that include capitellum and trochlea constitute approximately 6% of all distal humeral fractures and 1% of all elbow fractures. Despite the rarity of these injuries, an increasing number of clinical series have emerged, enhancing our understanding of these fractures.Case Report: A 26-year-old woman came to the emergency department with complaints of swelling and localized pain on the lateral side of her left elbow 2 hours after she fell off her motorcycle. Routine imaging such as plain radiographs and computed tomography scanning confirmed the fracture. She underwent open reduction and internal fixation surgery, stabilization of articular fragments with headless screws, and was fixated by a back slab and arm sling. The patient was also encouraged to do early elbow mobilization to avoid contractures and joint stiffness, routine follow-up every two weeks for a ROM evaluation. Preoperative Mayo Elbow-Performance Index score (MEPI) was 15, and postoperative 100.Discussion: The aim of capitellum fracture treatment is anatomical reconstruction and fixation to reduce the risk of non-union. In this case, we performed open reduction, secured two headless screws, which allow rigid fixation at the fracture site, provide fracture site compression through variable thread pitch design, and remained not removed later. These screws are suitable for use in anteroposterior and posteroanterior directions.Conclusion: The patient at two months follow-up has shown significant improvement. Accurate reduction, stable fracture fixation, and early postoperative mobilization were reported to provide good results with a MEPI score of 100.

Distal Humerus Hemiarthroplasty of the Elbow for Comminuted Distal Humeral Fractures in the Elderly Patient

2011 ◽  
Vol 71 (3) ◽  
pp. 635-642 ◽  
Author(s):  
Klaus J. Burkhart ◽  
Stefaan Nijs ◽  
Stefan G. Mattyasovszky ◽  
Ruben Wouters ◽  
Dominik Gruszka ◽  
...  
Keyword(s):  
Elderly Patient ◽  
The Elderly ◽  
Distal Humerus ◽  
Humeral Fractures ◽  
Distal Humeral Fractures

scholarly journals Distal Articular Fractures of the Humerus: Surgical Approach with Dynamic Elbow external Fixator

2020 ◽  
Vol 48 (01) ◽  
pp. 002-009
Author(s):  
Marcio Aurelio Aita ◽  
Ricardo Kaempf de Oliveira ◽  
Douglas Hideki Ikeuti ◽  
Gustavo Mantovani Ruggiero ◽  
Fernando Luvizoto de Carvalho ◽  
...  
Keyword(s):  
Range Of Motion ◽  
External Fixator ◽  
Humeral Fractures ◽  
Radiographic Analysis ◽  
Posttraumatic Arthritis ◽  
Dash Score ◽  
Articular Fractures ◽  
Flexion Extension ◽  
Distal Humeral Fractures ◽  
The Mean

Abstract Purpose To measure clinical and radiographic outcomes using external fixation in distal humeral fractures. Methods A total of 10 elderly patients, with a mean age of 71 (range 64–84 years) years old, with unstable distal humeral fractures were treated by percutaneous reduction and fixation with an articulated external fixator. The patients were assessed on range of elbow motion, patient disabilities of the arm, shoulder, and hand (DASH), and pain visual analog scale (VAS) and radiographic evaluation at 12 months. Results The mean range of motion was 134° of flexion, extension was of - 5°. All of the elbows were clinically stable. The mean VAS was 2.2, and the mean DASH score was 14.3. Radiographic analysis showed satisfactory reduction and consolidation. All of the patients showed congruence of concentric humerus-ulnar and radius and no patient had joint stiffness or posttraumatic arthritis of the elbow. Regarding complications, we observed a patient who presented with pain in the location of the ulnar pin, which was resolved with the removal of the pin. After two months, another patient had pneumonia and died. The follow-up was of 15.44 months. Conclusions A radiographic analysis of the patients showed fracture healing with joint congruity. In the functional clinical aspect, it was noted that patients had functional range of motionType of study/level of evidence Therapeutic IV

scholarly journals Distal Humeral Fractures-Current Concepts

2017 ◽  
Vol 11 (1) ◽  
pp. 1353-1363 ◽  
Author(s):  
James C. Beazley ◽  
Njalalle Baraza ◽  
Robert Jordan ◽  
Chetan S. Modi
Keyword(s):  
Adult Population ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Distal Humerus ◽  
Humeral Fractures ◽  
Implant Design ◽  
Improved Outcomes ◽  
Surgical Fixation ◽  
Distal Humeral Fractures ◽  
Distal Humerus Fractures

Background:Distal humerus fractures constitute 2% of all fractures in the adult population. Although historically, these injuries have been treated non-operatively, advances in implant design and surgical technique have led to improved outcomes following operative fixation.Methods:A literature search was performed and the authors’ personal experiences are reported.Results:This review has discussed the anatomy, classifications, treatment options and surgical techniques in relation to the management of distal humeral fractures. In addition, we have discussed controversial areas including the choice of surgical approach, plate orientation, transposition of the ulnar nerve and the role of elbow arthroplasty.Conclusion:Distal humeral fractures are complex injuries that require a careful planned approach, when considering surgical fixation, to restore anatomy and achieve good functional outcomes.

scholarly journals Management of displaced patella fracture with modified tension band wiring and percutaneous cannulated screws-a dilemma

2021 ◽  
Vol 7 (2) ◽  
pp. 351
Author(s):  
Vishal Singh ◽  
Avinash Gundavarapu ◽  
Alokeshwar Sharma ◽  
Tejas Patel
Keyword(s):  
Screw Fixation ◽  
Early Postoperative Period ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Prospective Clinical Study ◽  
Patella Fracture ◽  
Fixation Technique ◽  
Mean Values ◽  
The Mean ◽  
Better Than

<p class="abstract"><strong>Background:</strong> Displaced patella fracture has seen various surgical management methods in the past among which tension band wiring (TBW) and less invasive percutaneous cannulated cancellous (CC) screw  fixation are mostly preferred and debated on which is better option. The study has been designed to compare the functional outcome and various parameters of both the methods.</p><p class="abstract"><strong>Methods:</strong> The study was conducted as prospective clinical study in 30 skeletally mature patients with x-ray evidence of patella fracture fulfilling inclusion and exclusion criteria, out of which 15 were done tension band wiring and rest percutaneous cancellous screw and outcome graded as excellent, good, fair and poor based on Lysholm knee score.<strong></strong></p><p class="abstract"><strong>Results:</strong> The comparison of the mean values of the Lysholm score in patients operated with patella TBW (92.47) were better than with percutaneous CC screw fixation (88.93). Patella TBW was responsible for all the cases of infection 2 (6.67%) and delayed non-union 1 (3.33%). Whereas stiff was nearly equal in both the techniques. The comparison of the mean values of the knee flexion in patients operated by using percutaneous CC screw (107.27) was better than patella TBW (105.67).</p><p class="abstract"><strong>Conclusions:</strong> Patients managed with CC screw fixation technique achieved better knee function, especially in the early postoperative period. The reported advantages of the percutaneous fixation technique include avoidance of extended incisions, preservation of the blood supply to the patella, and the possibility of a simpler removal of all hardware in the clinical setting. These results suggest that the percutaneous CC screw technique may be a superior alternative to conventional modified tension band wiring.</p>

scholarly journals Comparison of open reduction and internal fixation with total elbow arthroplasty for intra-articular distal humeral fractures in older age: a retrospective study

2020 ◽  
Vol 23 (2) ◽  
pp. 94-99 ◽  
Author(s):  
Baik Jong Seok ◽  
Lee Sung Hyun ◽  
Hyun Tak Kang ◽  
Tae Hyun Song ◽  
Jeong Woo Kim
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Distal Humerus ◽  
Humeral Fractures ◽  
Total Elbow Arthroplasty ◽  
Humerus Fracture ◽  
Dash Score ◽  
Distal Humerus Fracture ◽  
Elbow Arthroplasty ◽  
Distal Humeral Fractures

Background: Intra-articular distal humeral fractures can be surgically challenging. It remains under discussion whether open reduction internal fixation (ORIF) or total elbow arthroplasty (TEA) is more beneficial for treatment of the elderly. This study aimed to compare the clinical and functional outcomes of ORIF and TEA for managing intra-articular distal humerus fractures in patients aged 65 years or older.Methods: Patients who underwent ORIF (n=28) or TEA (n=43) for in intra-articular distal humerus fracture between May 2008 and December 2018 were reviewed. Range of motion, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, radiologic outcomes, and surgical complications were evaluated at the final follow-up visit.Results: The ORIF and TEA groups showed a mean arc of flexion–extension of 97°±21° and 101°±12°, respectively. The mean MEPS and DASH scores were 94±15 and 27±12 points, respectively, in the ORIF group and 81±27 and 47±28 points in the TEA group. This difference was statistically significant. The incidence of total complications was similar between the groups.Conclusions: In patients older than 65 years with intra-articular distal humerus fracture, ORIF had better outcomes than TEA.

Biomechanics of Upper Extremity Double Plating

2019 ◽  
Vol 158 (02) ◽  
pp. 238-244 ◽  
Author(s):  
Philipp A. Michel ◽  
J. Christoph Katthagen ◽  
Lukas F. Heilmann ◽  
Felix Dyrna ◽  
Benedikt Schliemann ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Standard Of Care ◽  
Distal Humerus ◽  
Humeral Fractures ◽  
Distal Humeral Fractures ◽  
Clavicle Fractures ◽  
The Stability ◽  
Olecranon Fractures ◽  
Bicondylar Tibial Plateau ◽  
Double Plating

AbstractDouble plating (DP) is an established treatment modality in traumatology. For certain indications, such as open reduction and internal fixation of bicondylar tibial plateau fractures and distal humeral fractures, DP is standard of care in the clinical routine. However, the principles of DP can be transferred to other anatomic regions and indications. In the past years, DP has been brought more and more into focus. For revision cases, such as the treatment of fracture non-unions, DP seems generally useful. In anatomical locations with high torsional stress and bending forces, but also in regions with traction forces by muscles and tendons DP provides multiplanar stability and therefore seems to have biomechanical advantages. Usually two smaller implants can replace one larger implant. Thus, the number of points of fixation can be increased, the stability can be improved and soft-tissue irritations by bulky implants can be minimized. Along with the established indication and application at the distal humerus, there is biomechanical evidence in the current literature for DP of clavicle fractures and humeral shaft fractures. Furthermore, DP provides mechanical advantages in the treatment of certain proximal humeral fractures and olecranon fractures. This review of the literature summarizes the published literature on biomechanics of upper extremity DP.

Functional outcome following elbow release and hardware removal after bicolumnar fixation of distal humeral fractures

Injury ◽  
2020 ◽  
Vol 51 (7) ◽  
pp. 1592-1596 ◽  
Author(s):  
Christine Schemitsch ◽  
Brian Seeto ◽  
Luc Rubinger ◽  
Milena Vicente ◽  
Emil Schemitsch ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Hardware Removal ◽  
Humeral Fractures ◽  
Distal Humeral Fractures

scholarly journals Comparison of the Posterior-anterior Approach and Lateral-medial Approach for Complex AO/OTA Type C Intra-articular Fractures of Distal Humerus

2021 ◽  
Author(s):  
Yongchang Chen ◽  
Fei Xiao ◽  
Jian Chen ◽  
Lin Wei ◽  
Guoqing Zheng ◽  
...  
Keyword(s):  
Anterior Approach ◽  
Distal Humerus ◽  
Humeral Fractures ◽  
Medial Approach ◽  
Distal Humeral Fractures ◽  
Vas Scores ◽  
Type C ◽  
One Year ◽  
The One

Abstract Objective: The aim of this retrospective study was to investigate clinical effects of the treatment of intra-articular distal humeral fractures via the combined posterior olecranon osteotomy and anterior approach and the combined lateral Kaplan approach associated with the medial approach. Methods: Between July 2010 and September 2019, 28 cases of intercondylar fractures of the distal humerus (AO/OTA type C) were treated by open reduction and internal fixation (ORIF) via the posterior and anterior approach and combined lateral-medial approach, which were divided into the P-A (n = 13) and L-M (n = 15) groups, respectively. The outcomes in terms of function were assessed using the range of motion (ROM) of the elbow and forearm, humerotrochlear (HT) angle, Visual Analogue Scale (VAS) scores, Mayo Elbow Performance Score (MEPS), and efficacy grade evaluated using the scoring system of Orthopaedic Trauma Association (OTA) at the one-year follow-up. Results: The flexion-extension of elbows and pronation-supination of forearms were respectively 114.1° ± 12.4° and 157.3° ± 9.6° in the P-A group and 117.1° ± 14.5° and 161.3° ± 10.7° in the L-M group. No significant difference was observed between the two groups for the elbow and forearm ROM (p > 0.05). Furthermore, surgery duration, blood loss volume, HT angle, MEPS, VAS scores, OTA rating, and the morbidity of postoperative complications during the one-year follow-up did not differ between groups. Conclusion: The posterior olecranon osteotomy and anterior approach can be used efficiently for exposure of complex distal humeral injuries with similar clinical efficacy and complications in the treatment of intra-articular distal humeral fractures as compared to the lateral-medial approach.

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