Comparison of Functional Outcomes in the Management of Intercondylar Fractures by Olecranon Osteotomy Approach versus Triceps on and Triceps off Approach

Intercondylar fracture of the distal humerus is a relatively rare and challenging intra-articular elbow fracture, with available choice of surgical treatment includes open reduction and extensive internal fixation. This systematic review aims to evaluate the effectiveness of the surgical approach regarding the functional outcome following intercondylar fracture treatment. A systematic search on literature was performed online from the inception dates to November 2020. Main outcome of interest included functional outcomes, Mayo Elbow Performance Score (MEPS) and The Disabilities of the Arm, Shoulder and Hand (DASH) Score. Animal studies, case reports, review articles and non-English papers were excluded. Four articles were included in this review. The functional outcome was different among the olecranon osteotomy approach, triceps on with the triceps sparing approach and triceps off with the triceps lifting approach or the TRAP approach. Triceps on approach with triceps sparing had lower MEPS in patients above 60 years of age but satisfactory in younger patients, while olecranon osteotomy approach showed excellent MEPS rate in all age groups. Olecranon osteotomy approach gives better exposure for more accurate anatomical reduction of the intra articular fracture resulting in better functional outcome. Mean DASH score was significantly higher in Triceps Reflecting anconeus (TRAP) group. Olecranon osteotomy approach was found to be better than triceps on approach, with better functional outcome. However, other triceps off (TRAP) did not show any significant differences in terms of functional outcome in the management of intercondylar fractures. Keywords: intercondylar fractures, olecranon osteotomy, triceps on, triceps off, functional outcome.

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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 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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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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A study of clinicoradiological and functional outcomes of intramedullary nailing in diaphyseal radius ulna fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20194821 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1150

Author(s):

Parag M. Tank ◽

Yash S. Shah ◽

Rutvik D. Dave ◽

Vijay J. Patel

Keyword(s):

Functional Outcome ◽

Intramedullary Nailing ◽

Functional Outcomes ◽

Bone Fractures ◽

Case Series ◽

Functional Results ◽

Dash Score ◽

Retrospective Case ◽

Non Union ◽

Case Series Study

Background: The aim of this study was to evaluate the results of intramedullary nailing in diaphyseal fractures of radius and ulna in age group of 10 to 49 years and to understand its clinicoradiological and functional results.Methods: This is a retrospective case series study of forearm bone fractures and the selected management for the same over a period of 3 years. We chose the cases in which intramedullary nailing was the treatment modality which were followed up over a period of minimum 6 months. Patients with galeazzi variety, monteggia variety, pathological fracture or non-union after previous surgery were excluded. The outcomes were then evaluated with disabilities of the arm, shoulder and hand (DASH) score, Green and O’Brien score, and Grace and Eversmann functional outcome score.Results: Of the 22 patients, 10 patients had excellent functional outcome according to Grace and Eversmann score, 7 patients had good outcome, 4 patients had acceptable while 1 was unacceptable. Green and O’Brien also had similar results, except that patients among fair category were 3 and poor category were 3. The mean DASH score was 16.2.Conclusions: This study shows that closed method for fixation by intramedullary nailing of both bone forearm fractures leads to excellent to good functional outcomes (according to DASH score, Green and O Brien, and Grace and Eversmann score) with less complications. In 6 months follow up x ray there is radiological union in all cases with no angulation, malunion or non-union.

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Comparative Study of Functional Outcomes between OTA/AO type C, Gustilo type I/II Open Fractures and Closed Fractures of the Distal Humerus Treated by Open Reduction and Internal Fixation.

10.21203/rs.3.rs-783337/v1 ◽

2021 ◽

Author(s):

Chen chen ◽

Dan Xiao ◽

Ting Li ◽

Maoqi Gong ◽

Yejun Zha ◽

...

Keyword(s):

Internal Fixation ◽

Functional Outcomes ◽

Open Reduction ◽

Distal Humerus ◽

Open Fractures ◽

Type I ◽

Dash Score ◽

Fracture Group ◽

Type C ◽

Closed Fractures

Abstract Background: To evaluate the difference of functional outcomes between OTA/AO type C, Gustilo type I/II open fractures and closed fractures of the distal humerus after open reduction and internal fixation.Methods: We retrospectively analyzed the clinical data of patients with OTA/AO-C distal humerus fractures who were treated in our department from January 2014 to December 2016. The patients were divided into an open fracture group and a closed fracture group. Their baseline characteristics and functional outcomes were analyzed and comparedResults: A total of 64 patients treated by operative fixation were identified (25 open and 39 closed injuries), and the average follow-up time was 35.1±13.6 months. There were no significant differences in the hospitalization time, operation time, intraoperative blood loss, medical costs, range of motion (ROM) of the elbow, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, or complications between the two groups (P>0.05).Conclusion: OTA/AO type C, Gustilo I/II distal humeral open fractures can yield satisfactory clinical results similar to those of closed distal humeral fractures after open reduction and internal fixation.Level of Evidence: Therapeutic Level III; Retrospective Cohort Comparison; Treatment Study.

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A Study on Functional Outcomes after Plating of Middle Third Fractures of Clavicle

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/573 ◽

2020 ◽

Vol 7 (47) ◽

pp. 2793-2798

Author(s):

Pardhasarathi B ◽

Balaji Rao R ◽

Manikumar C.J.

Keyword(s):

Functional Outcome ◽

Conservative Management ◽

Functional Outcomes ◽

Clavicle Fracture ◽

Dash Score ◽

Non Union ◽

Plating Technique ◽

Fracture Clavicle ◽

Comminuted Fractures ◽

Clavicle Fractures

BACKGROUND Fracture clavicle is one of the most common conservatively treated fractures. Conservative management showed lesser rates of non-union and satisfactory results for fracture clavicle initially. Recent studies showed that the functional outcome following conservative management was not as optimal as it was thought to be. With changing injury patterns, increased incidence of high velocity trauma and increased functional demands of the modern patients which led to thorough evaluation of the functional outcomes following conservative management of fracture clavicle, the outcome was not optimal. Recent studies showed increased rate of non-union among conservatively managed cases compared to those which were fixed internally. Some found residual deficits among patients treated conservatively. We wanted to study the functional outcome and complications following internal fixation of clavicle fractures by using plating techniques. METHODS This prospective study was done in Department of Orthopaedics, Andhra Medical College, Visakhapatnam. We studied functional outcome of 30 fractures of clavicle which were fixed using plating technique during the period October 2016 - October 2018. Thirty patients (n = 30) were treated with plating technique using precontoured locking plates and recon plates. The fractures in this study were middle third clavicle fractures which were divided into two types based on the classification of Robinson. Type 2 Robinson clavicle fracture implies that it is a middle third clavicular fracture, which is further divided based on fracture morphology. 2b1: Displaced simple or wedge comminuted fractures 2b2: Segmental comminuted fractures. In this study, superior plating was done. The implants used were precontoured LCP and recon plates. Functional outcome was assessed using Constant Murley scoring and Quick Dash score at 10 weeks. The follow up period was for 1 year - October 2016 to October 2018. RESULTS The average time of union for the fractures treated with plating technique in our study was around 10.2 weeks. The mean Constant Murley score of our study was 91. Eighteen out of 30 patients had excellent outcomes. One patient had fair outcome due to stiffness of the shoulder. 10 patients had good result. The average DASH score of the patients was about 9.8. CONCLUSIONS Treatment of fracture middle third of clavicle using plating technique provides good functional outcome and faster recovery with minimal complications. KEYWORDS Clavicle A02.835.232.087.227, Wounds and Injuries C26, Postoperative Complications C23.550.767

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Comparative study of functional outcomes between OTA/AO type C, Gustilo type I/II open fractures and closed fractures of the distal humerus treated by open reduction and internal fixation

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04817-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Chen Chen ◽

Dan Xiao ◽

Ting Li ◽

Maoqi Gong ◽

Yejun Zha ◽

...

Keyword(s):

Internal Fixation ◽

Functional Outcomes ◽

Open Reduction ◽

Distal Humerus ◽

Open Fractures ◽

Type I ◽

Dash Score ◽

Fracture Group ◽

Type C ◽

Closed Fractures

Abstract Background To evaluate the difference of functional outcomes between OTA/AO type C, Gustilo type I/II open fractures and closed fractures of the distal humerus after open reduction and internal fixation. Methods We retrospectively analyzed the clinical data of patients with OTA/AO-C distal humerus fractures who were treated in our department from January 2014 to December 2016. The patients were divided into an open fracture group and a closed fracture group. Their baseline characteristics and functional outcomes were analyzed and compared. Results A total of 64 patients treated by operative fixation were identified (25 open and 39 closed injuries), and the average follow-up time was 35.1 ± 13.6 months. There were no significant differences in the range of motion (ROM) of the elbow, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, complications, hospitalization time, operation time, intraoperative blood loss, or medical costs between the two groups (P > 0.05). Conclusion OTA/AO type C, Gustilo I/II distal humeral open fractures can yield satisfactory clinical results similar to those of closed distal humeral fractures after open reduction and internal fixation. Level of evidence Therapeutic Level III; Retrospective Cohort Comparison; Treatment Study.

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Comparative Analysis of Results of Paratricipital Approach and Olecranon Osteotomy in Non Comminuted Distal Humerus Fractures - A Retrospective Study Conducted at a Tertiary Hospital in Kolkata

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/602 ◽

2021 ◽

Vol 8 (37) ◽

pp. 3316-3322

Author(s):

Subhadeep Ghosh ◽

Sunit Hazra

Keyword(s):

Retrospective Study ◽

Internal Fixation ◽

Functional Outcomes ◽

Open Reduction ◽

Age Groups ◽

Distal Humerus ◽

Extensor Mechanism ◽

Surgical Approaches ◽

Humerus Fractures ◽

Distal Humerus Fractures

BACKGROUND Intercondylar humerus fractures and low transcondylar type fractures of distal humeral often require surgical exposure and anatomical reduction of the articular surface as well as stabilization of the medial and lateral columns of the distal humerus. Traditionally, these injuries have been treated surgically with various extensor mechanism-disrupting surgical approaches. These approaches have often led to delayed union or non-union of the olecranon, triceps weakness, and osteotomy-related prominent implants. To avoid these problems, various extensor mechanism-sparing approaches that provide bicolumnar exposure of the distal part of the humerus have been described, including triceps-splitting and reflecting techniques. The paratricipital approach was developed to avoid the problems of olecranon osteotomy approach for non comminuted distal humerus fractures. The purpose of this study was to compare the paratricipital approach with olecranon osteotomy and evaluate their effects on the functional outcomes of intercondylar fractures of the distal humerus managed with open reduction and internal fixation (ORIF) by reviewing 38 cases of intercondylar distal humerus fractures surgically managed with either of the approaches during 2015 - 2017. METHODS The retrospective study was conducted at our institution, R.G. Kar Medical College, Kolkata from May 2015 to May 2017. OA type C1 and C2 fractures were included in the study. Type C3 fractures were excluded from the study. Distal humeral open reduction and internal fixation (ORIF) was performed with either orthogonal or parallel plate constructs in 38 patients, where paratricipital approach was used in 21 patients and olecranon osteotomy was done for 17 patients. RESULTS Patients in the paratricipital approach group seems to have better range of motion in terms of flexion and extension. Moreover, mayo elbow performance score (MEPS) of the paratricipital group is better than that of olecranon osteotomy group, even more so in younger age groups. CONCLUSIONS We found that ORIF via the paratricipital approach would confer better functional outcomes for simple intra-articular distal humerus fractures in patients of all age groups. KEYWORDS Distal Humerus Fracture, Paratricipital, Olecranon Osteotomy

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Parachute-Induced Pectoralis Major Tears in Military Servicemembers: What Is the Functional Recovery?

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211014494 ◽

2021 ◽

Vol 9 (6) ◽

pp. 232596712110144

Author(s):

K. Aaron Shaw ◽

Scott Brown ◽

Colleen M. Moreland ◽

Ivan J. Antosh ◽

Stephen A. Parada

Keyword(s):

Functional Outcome ◽

Outcome Assessment ◽

Functional Recovery ◽

Functional Outcomes ◽

Pectoralis Major ◽

Injury Mechanism ◽

Dash Score ◽

Operative Repair ◽

Significant Difference ◽

The Mean

Background: Although the most common injury mechanism for pectoralis major (PM) tears is an eccentric loading mechanism typically caused by bench pressing, within the military, there is a unique injury mechanism associated with airborne operations. The results of operative repair for these parachute-induced PM tears have not been previously reported. Purpose/Hypothesis: To assess the functional outcomes in military servicemembers undergoing operative repair of parachute-induced PM tears. We hypothesized that functional recovery would be impaired with delayed surgical intervention. Study Design: Cohort study; Level of evidence, 3. Methods: Included were active duty military servicemembers who underwent operative repair for PM tears caused by a parachute-induced mechanism. Charts were reviewed to identify characteristic, injury, and surgical variables. Patients completed the functional outcome assessment with the Disabilities of the Arm, Shoulder and Hand (DASH) and the American Shoulder and Elbow Surgeons (ASES) questionnaires. Outcomes were compared between patients treated within 6 weeks of injury and those treated beyond 6 weeks. Results: Of the 68 identified PM tears, 25 were the result of parachute-induced mechanisms. A total of 13 patients consented and completed the functional outcome assessment. The mean patient age was 30.6 ± 6.4 years, and the mean follow-up period was 5.46 ± 1.26 years. Ten patients underwent repair within 6 weeks of injury, and the remaining 3 patients underwent repair at a mean of 338 days after injury (95% CI, -42.8 to 718.8 days), a significant difference between groups ( P = .006). All 13 patients were able to return to military duties at a mean of 6 months from injury. Patients treated within 6 weeks of injury had significantly higher functional outcomes (DASH score, 6.17 vs 26.67; P = .018; ASES score, 85.97 vs 49.5; P = .008), with greater strength performance compared with preinjury (bench press, 90.58% vs 38.95%; P = .0057; push-ups, 81.9% vs 23.8%; P = .023) compared with patients treated beyond 6 weeks of injury. Conclusion: Operative repair of parachute-induced PM tears within 6 weeks of injury provided a superior functional and strength recovery when compared with delayed surgical repair. Acute repair should be recommended for military servicemembers who experience this unique injury mechanism.

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Scaphoid Nonunion Is a Disabling Problem in a Military Population

Hand ◽

10.1177/15589447211003177 ◽

2021 ◽

pp. 155894472110031

Author(s):

Nicholas H. Lake ◽

Rafae Khan ◽

Kyle W. Mombell ◽

Mary Fergus ◽

Dominic Gomez-Leonardelli

Keyword(s):

Functional Outcome ◽

Military Service ◽

Functional Outcomes ◽

High Rate ◽

Scaphoid Nonunion ◽

Military Population ◽

Outcome Scores ◽

The Mean ◽

Return To Duty

Background Scaphoid nonunion can occur in up to 55% of displaced scaphoid fractures. Long-term functional outcomes of this injury are lacking. In addition, no study has published rate of return to active military service after this injury. Our goal was to educate providers and patients on expected functional outcomes and return to duty after treatment of scaphoid nonunion. Methods We conducted a retrospective review of patients who underwent scaphoid nonunion repair at our institution from 2008 to 2017. The primary outcome measures were union rates, return to duty rates, and functional outcome scores obtained by telephone call. A total of 144 patients were included and 40 responded to our call for long-term follow-up. Results A total of 72% of patients achieved union after surgery, 18% required revision surgery, and 74% of patients were able to return to full duty after surgery. However, this number progressively decreased at 1, 2, and 5 years after surgery. At an average of 5.9 years after surgery, the mean Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) score was 23.9. The mean qDASH for patients who achieved union (21.9) was significantly lower than those with persistent nonunion (29.2) ( P = .0115). Conclusion Scaphoid nonunion is a difficult problem in the military. We found a high rate of persistent nonunion often requiring revision to partial or full wrist arthrodesis. In addition, our long-term functional outcome scores demonstrate significant disability after this injury, even when union is achieved. This information can help us better counsel our patients and set expectations after treatment of this injury.

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