Functional and radiological outcomes of distal humerus fractures treated with pre-contoured locking compression plate

<p><strong>Background: </strong>Distal humerus intra-articular fractures are one of the complicated fractures managed by orthopaedic surgeons. We did a prospective and a retrospective study on 21 patients with these fractures treated with pre-contoured locking compression plate.</p><p><strong>Methods: </strong>The<strong> </strong>21 patients in this series were followed for a minimum of 1 year. The prospective study cases were followed at 3 months, 6 months and annually. The rating system of the Mayo elbow functional scoring system was used. The radiological evaluation was done using standard AP and lateral views.<strong></strong></p><p><strong>Results: </strong>We had 14 patients with range of motion of 50-100 degrees. There was only one patient with range of motion of &lt;50 degrees. 6 patients had the maximum range motion of &gt;100 degrees. We had 6 (23.57%) excellent, 9 (42.85%) good, 5 (23.80%) fair and 1 (4.7%) poor in the Mayo elbow scoring at the end of 1 year. We were able to compare our outcomes with a study done by Kumar et al done in 2017. They had 27 (89.66%) of excellent and good results as opposed to 27 (79.4%) in our study. Out of 21 patients in our study 17(80.95%) patients had good 11 (52.5%) / excellent 6 (28.5%) results. This was comparable with Jupiter et al. His study of 34 patients 26 (79.40/0) patients showed good 14 (41%) / excellent 13 (38.4%) result.<strong></strong></p><p><strong>Conclusions: </strong>Pre-contoured locking compression plate appears to be technically an ideal implant for comminuted osteoporotic bone providing an angle stable construct.</p>

Coronal Shear Fractures of the Distal Humerus

Coronal shear fractures of the distal humerus are rare, frequently comminuted, and are without consensus for treatment. The aim of this paper is to review the current concepts on the diagnosis, classification, treatment options, surgical approaches, and complications of capitellar and trochlear fractures. Computed Tomography (CT) scans, along with the Dubberley classification, are extremely helpful in the decision-making process. Most of the fractures necessitate open reduction and internal fixation, although elbow arthroplasty is an option for comminuted fractures in the elderly low-demand patient. Stiffness is the most common complication after fixation, although reoperation is infrequent.

Standardized fracture creation in the distal humerus and the olecranon for surgical training and biomechanical testing

Introduction Surgical training and biomechanical testing require models that realistically represent the in vivo injury condition. The aim of this work was to develop and test a method for the generation of distal humerus fractures and olecranon fractures in human specimens, while preserving the soft tissue envelope. Methods Twenty-one cadaveric upper extremity specimens (7 female, 14 male) were used. Two different experimental setups were developed, one to generate distal humerus fractures and one to generate olecranon fractures. Specimens were placed in a material testing machine and fractured with a predefined displacement. The force required for fracturing and the corresponding displacement were recorded and the induced energy was derived of the force–displacement graphs. After fracturing, CT imaging was performed and fractures were classified according to the AO classification. Results Eleven distal humerus fractures and 10 olecranon fractures with intact soft tissue envelope could be created. Distal humerus fractures were classified as AO type C (n = 9) and as type B (n = 2), all olecranon fractures were classified as AO type B (n = 10). Distal humerus fractures required significantly more load than olecranon fractures (6077 N ± 1583 vs 4136 N ± 2368, p = 0.038) and absorbed more energy until fracture than olecranon fractures (17.8 J ± 9.1 vs 11.7 J ± 7.6, p = 0.11), while the displacement at fracture was similar (5.8 mm ± 1.6 vs 5.9 mm ± 3.1, p = 0.89). Conclusion The experimental setups are suitable for generating olecranon fractures and distal humerus fractures with intact soft tissue mantle for surgical training and biomechanical testing.

Surgical treatment of patients with extra-articular fractures of the distal humerus

Background. The article deals with extra-articular fractures of the distal humerus, according to the АО/ASIF classification, which includes types 12A–C, depending on the plane of the fracture and the nature of the fragment displacement. The purpose was to study the features of the lower third humeral fractures and to conduct a comparative analysis of the outcomes of surgical treatment. Material and methods. One hundred and twenty-seven patients with extra-articular fractures of the distal humerus were under observation. For retrospective analysis, they were divided into a comparison group (n = 92) who underwent traditional bone osteosynthesis and a study group (n = 35) in whom a rod-type external fixation device developed by us was used. The short- and long-term functional results were studied using the Mayo Elbow Performance Score. Results. Various indicators, established by us for comparison, and treatment outcomes were analyzed in 101 patients (comparison group — 68 people, study group — 33). Many values of these parameters were quite comparable in terms of the age, gender, hospitalization terms, duration of surgeries, etc., but the revealed differences in indicators still did not reach the level of statistical reliability (p > 0.05). Evaluation of the clinical use of the device proposed by us showed restoration of the humeral anatomy, quite comparable to that in bone osteosynthesis, and the achievement of the final result of treatment. However, the number of complications by type and by total number was significantly higher (4.5 times; p ˂ 0.001) in the comparison group, where it accounted for the largest share of cases of neuropathies (16.18 %), nonunions (8.82 %), elbow contractures (8.82 %) and heterotopic ossification (4.42 %). The final score on the Mayo Elbow Performance Score in the comparison group was 84.9 ± 10.2 points, in the study group — 92.6 ± 3.7 points. At the same time, the total number of positive treatment outcomes after bone osteosynthesis was 66.18 %, after transosseous osteosynthesis — 81.82 %. Conclusions. The analysis of the data obtained allows us to recommend a method of minimally invasive osteosynthesis with a rod device of external controlled fixation as a method of choice for wider clinical use in the treatment of patients with lower third humeral fractures.