1
|
Osteosynthesis of AO/OTA 13-C3 distal humeral fractures in patients older than 70 years. J Shoulder Elbow Surg 2018; 27:291-297. [PMID: 29162306 DOI: 10.1016/j.jse.2017.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/30/2017] [Accepted: 09/09/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The purpose of this retrospective case series was to examine the AO Foundation and Orthopaedic Trauma Association (AO/OTA) 13-C3 distal humeral fractures treated with open reduction-internal fixation (ORIF) in patients older than 70 years. METHODS During an 8-year period, 21 patients older than 70 years with AO/OTA 13-C3 distal humeral fractures were treated with ORIF performed by 2 senior upper extremity traumatologists. There were 16 patients with >1 year of follow-up, with a mean age of 78 (70-84) years. RESULTS At a mean follow-up of 4 years (1-8 years), all 16 patients demonstrated radiographic signs of bone union. Three patients underwent reoperations, including irrigation and débridement for postoperative infections (n = 2) and removal of implant for symptomatic olecranon intramedullary screw (n = 1). The mean postoperative total arc of ulnohumeral motion was 97° (80°-145°), including a mean flexion of 117° (106°-126°) and flexion contracture of 20° (14°-26°). The mean pronation was 69° (55°-85°), and supination was 78° (74°-9°0). The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 19 (standard deviation, 6.9; confidence interval, 15.4-22.8), and the mean Mayo Elbow Performance Score was 91 (standard deviation, 8.2; confidence interval, 86-95). CONCLUSIONS ORIF remains a reliable option for treatment of AO/OTA 13-C3 distal humeral fractures in elderly patients. Excellent clinical outcomes can be achieved with preservation of motion and arm function through anatomic reduction, rigid internal fixation, and early mobilization.
Collapse
|
2
|
Crönlein M, Lucke M, Beirer M, Pförringer D, Kirchhoff C, Biberthaler P, Braun KF, Siebenlist S. Polyaxial locking plates in treating distal humeral fractures: a comparative randomized trial for clinical outcome. BMC Musculoskelet Disord 2017; 18:547. [PMID: 29282027 PMCID: PMC5745613 DOI: 10.1186/s12891-017-1910-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 12/13/2017] [Indexed: 12/30/2022] Open
Abstract
Background Management of distal humeral fractures remains to be one of the most challenging aspects in trauma surgery. Low profile plating systems with variable angle screw fixation represent a crucial advancement to the established angular stable locking plates with considerable attention in current research. The aim of the prospective randomized trial was to review the preliminary results and patients’ outcome following treatment with these newly developed implants and to rule out potential differences in fracture treatment of two different plating systems. Methods Twenty patients with distal humeral fractures (AO 13-A1 – AO 13-C3) were included in the current study since 2014. After completing the randomization plan, patients were distributed into two groups for different variable angle locking plates (DePuy Synthes® VA-LCP vs. Medartis® Aptus Elbow). Functional elbow scoring (ROM, MEPS, QuickDASH) served as primary outcome parameter, while radiological fracture consolidation served as secondary outcome parameter. Follow-ups were conducted 6 weeks, 12 weeks, 6 months and 12 months after the operation. Results Seventeen of 20 patients (85%) concluded all follow-up examinations. Postoperative elbow extension deficiencies showed significant differences between the two groups in all follow-up examinations with a mean of Ø 18 +/− 7.4 degrees in the DePuy Synthes® VA-LCP group compared to a mean of Ø 6.5 +/− 7.5 degrees in the Medartis® Aptus Elbow group (p = 0.002) 12 months postoperatively. Functional scoring showed a disparate pattern. The Medartis® Aptus Elbow group achieved significantly better MEP scores during follow-up. However, the analysis of the QuickDash revealed better results of the DePuy Synthes® VA-LCP group in the first half and better results of the Medartis® Aptus Elbow group in the second half of the follow-up examination instead. Conclusions Considering the complexity of distal humeral fractures, the usage of anatomically preshaped low profile variable angle locking plates for operative treatment leads to good clinical results. Even though there might be some advances of the Medartis® Aptus Elbow plating system concerning postoperative ROM and elbow function, a consistent difference in the overall clinical outcome between the two plating systems could not be detected. Trial registration https://clinicaltrials.gov/ct2/show/NCT03272490 Retrospectively Registered 1. September 2017.
Collapse
Affiliation(s)
- Moritz Crönlein
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Martin Lucke
- Department of Trauma Surgery, Chirurgisches Klinikum München Süd, Am Isarkanal 30, 81379, Munich, Germany
| | - Marc Beirer
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Dominik Pförringer
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Karl F Braun
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany. .,Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| |
Collapse
|
3
|
Management of comminuted fractures of the distal humerus: clinical outcome after primary external fixation versus immediate fixation with locking plates. Arch Orthop Trauma Surg 2017; 137:1693-1698. [PMID: 28929365 DOI: 10.1007/s00402-017-2792-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The surgical treatment of comminuted fractures of the distal humerus remains a challenging problem. The aim of the present study was to compare the clinical outcomes of primary external fixation with second-staged open reduction and internal fixation (ORIF) and initial definitive internal fixation in surgically treated patients with comminuted distal humerus fractures. DESIGN Retrospective comparative study. SETTING Level one trauma center. PATIENTS A total of 24 patients (median age 52 years; range 14-84 years) were included: 15 patients were treated with initial definitive internal fixation with pre-contoured locking compression plates (group A), and 9 patients underwent surgical treatment with primary external fixation and second-staged ORIF (group B). Only patients with C3 fractures according to the AO classification were included in the study. MAIN OUTCOME MEASUREMENT Disability of the Arm, Shoulder and Hand (DASH) and Mayo Elbow Performance Score (MEPS). INTERVENTION External fixation internal fixation with locking plates. RESULTS The median follow-up was 37 months for both groups. There was a significantly higher median elbow extension deficit in group B (39°) compared to group A (17°) (p = 0.048). The mean DASH score in group A was 14 and 12.5 in group B. MEPS showed that more patients in group A achieved excellent results; however, there was no significant difference compared to group B. CONCLUSIONS Primary external fixation with second-staged ORIF demonstrated a higher complication rate and significantly greater loss of extension compared with initial definitive internal fixation. Thus, the use of primary external fixation in cases of comminuted distal humerus fractures appears to have a negative influence on the patient outcomes. LEVEL OF EVIDENCE Therapeutic level III.
Collapse
|