A PROSPECTIVE FOLLOW UP STUDY OF FUNCTIONAL OUTCOME OF SUPRACONDYLAR HUMERUS FRACTURE WITH INTERCONDYLAR EXTENSION TREATED WITH OLECRANON OSTEOTOMY APPROACH

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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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 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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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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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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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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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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Effects Supervised Versus Home-Based Rehabilitation on Functional Outcome after Surgical Fixation

10.53350/pjmhs2115102692 ◽

2021 ◽

Vol 15 (10) ◽

pp. 2692-2694

Author(s):

Haroon-ur- Rehman Gillani ◽

Muhammad Umar Habib ◽

Danish Hassan ◽

Syed Muhammad Shah

Keyword(s):

Functional Outcome ◽

Distal Humerus ◽

Healing Time ◽

Radiographic Evaluation ◽

Home Based ◽

Elbow Fractures ◽

Surgical Fixation ◽

Humerus Fractures ◽

Distal Humerus Fractures

Background: The focus for early postoperative motion in stable fixation is aimed at good restoration of joint anatomy in relation to movements, strength, and joint play and to compare the functional outcomes after the surgical repair of distal humerus fractures in contrast with supervised and home-based rehabilitation. Aim: To provide guidelines to effectively manage the post-operative functional complications. Method: Sixty-four patients with the distal humerus fractures were treated surgically, participated in the study at the mean follow up of 6 months. Mayo Elbow Performance Score (MEPS), Disabilities of the Arm shoulder and Hand (DASH), Visual Analogue Scale and Goniometer, radiographic evaluation was done to assess outcomes at baseline (2nd week after cast removal), 10th week &6th month post-operative. Results: Among 60 patients, average MEPS, DASH, Arc of motion was significantly better in supervised rehabilitation group in contrast with home-based rehabilitation group (p=0.00, CI 95%). Average healing time observed on radiographs was 10-12 weeks. The overall complication rate was only 4.7%, while most of the minor complications resolved without any intervention. Conclusions: Outcomes of distal humerus fractures were good to excellent in both groups, whereas supervised rehabilitation provided better outcomes in context with ranger of motion, mobility, and functionality. Keywords: Olecranon Osteotomy, Elbow Fractures, Functional outcome, Elbow Rehabilitation

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Functional outcome of the treatment of AO-ASIF type C distal humerus fracture using Lambda plate

Journal of Gandaki Medical College-Nepal ◽

10.3126/jgmcn.v13i2.31933 ◽

2020 ◽

Vol 13 (2) ◽

pp. 128-133

Author(s):

Krishna Bahadur Bista ◽

Rabeendra Prasad Shrestha ◽

Bhola Shrestha ◽

Ishwar Sharma Kandel ◽

Rabi Mohan Dakal

Keyword(s):

Range Of Motion ◽

Functional Outcome ◽

Distal Humerus ◽

Humerus Fracture ◽

P Value ◽

Fracture Treatment ◽

Distal Humerus Fracture ◽

Number Of Patients ◽

Type C

Introduction: Although the use of two plates for the treatment of type-C distal humerus fracture is popular, site of plate placement still is under debate. Use of Lambda plate for the fracture treatment can be easier and settle the dispute. This study aims to evaluate the functional outcome of the surgery using Lambda Plate. This can be a reference for surgeons and helps them make the decision about choice of implant for type C distal humerus fracture treatment among Nepalese people. Methods: This interventional study used Lambda plate for the treatment of type C fracture of distal humerus. Patients were examined at 4, 12, and 24 weeks respectively for the measurement of the outcome. Visual analogous scale was used for assessment of pain, range of motion for functional recovery and Mayo Elbow Performance Score was used for the assessment of functional outcome. Paired-samples t-test and linear regression was used to for data analysis. Results: Functional outcome at the last follow-up was excellent in 24(53.33%) patients, good in 18(40%) patients and fair in 3(6.67%) patients. Range of motion of elbow increased significantly with every follow-up (p-value <0.001). Average angle of flexion at last follow-up was 117.53°±11.74 while loss of extension was 7.53°±4.86. Average number of patients had their fracture union at 19.84±2.38 weeks. There was no association of age, sex and union weeks with functional outcome when measured with MEPS. Conclusion: Fixation of distal humerus fracture by using Lambda plate gave excellent and satisfying outcome in terms of pain, range of motion and objective functional outcome.

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STUDY OF THE FUNCTIONAL OUTCOME OF SURGICAL MANAGEMENT OF INTRA-ARTICULAR DISTAL HUMERUS FRACTURE (AO/OTA TYPE C) IN ADULTS

10.36106/ijsr/0809423 ◽

2020 ◽

pp. 1-3

Author(s):

Ravindra Prasad ◽

L B Manjhi

Keyword(s):

Internal Fixation ◽

Range Of Motion ◽

Functional Outcome ◽

Surgical Management ◽

Distal Humerus ◽

Humerus Fracture ◽

Joint Surface ◽

Distal Humerus Fracture ◽

Complex Anatomy ◽

Type C

Introduction: Distal humerus fracture in adults particularly complete articular (AO/OTA Type C) remain some of the most difficult injuries to manage. Complex anatomy of distal humerus combined with multifragmented fracture, sparse soft tissue cover with adjacent neurovascular structures poses great difficulty for treatment. Goal of treatment is to obtain a painless, stable and mobile elbow joint through a systematic approach. Aim: to study the functional outcome of surgical management of complete articular distal humerus fracture in adults. Method: a prospective study comprising of 20 patients treated surgically with open reduction and internal fixation using Orthogonal plating (dorsolateral and medial 3.5mm LCP) through trans olecranon approach. Result: Mean age of patients was 36.6 years (range 19 to 58 years) with male dominance, most fractures were of type 13C1 (AO/OTA). RTA accounts for most common mode of injury, majority of them being left sided. Mean operative time was 130 minutes. Complications included one case of superficial infection, 3 cases of ulnar neuropathy and non-union in 2 cases. Mean range of motion of elbow was 89 degree. Functional outcome assessed using Mayo Elbow Performance Score (MEPS) shown Excellent result in 12 cases, good to fair results in 6 and poor result in 2 cases. Conclusion: Anatomical restoration of joint surface and rigid internal fixation with bicolumnar orthogonal plating allowing early range of motion is the key for obtaining good functional results in complete articular distal humerus fractures. However, outcomes do deteriorate with increasing fracture complexity.

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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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