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Jung HS, Won YS, Choi YS, Lee JS. Risk factors for hardware-related complications after extra-articular distal humerus fracture fixation using an anatomical locking plate. Eur J Trauma Emerg Surg 2023; 49:125-131. [PMID: 35913540 DOI: 10.1007/s00068-022-02064-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/10/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE We aimed to identify the incidence and risk factors of hardware-related complications in patients treated with anatomical locking plate fixation for extra-articular distal humerus fractures. METHODS From 2013 to 2020, patients with extra-articular distal humerus fractures who underwent open reduction and internal fixation with an extra-articular distal humerus locking plate (EADHP) were retrospectively reviewed and categorized according to the presence/absence of hardware-related complications. Hardware-related complications were defined as the occurrence of skin prominence on the plate and discomfort in activities of daily living. Patient demographics, the lateral condylar angle, lateral body length, shaft-condylar angle of the humerus, and plate length were analyzed. RESULTS Of the 29 patients, 10 (34%) did not develop hardware-related complications (group A), whereas 19 (66%) did (group B). Patient demographics did not differ between the groups. However, the number of patients who underwent hardware removal was significantly greater in group B (16/19) than in group A (4/10; p = 0.032). Radiologic assessment revealed no significant difference in the lateral condylar or shaft-condylar angle. However, the lateral body length was greater in group A than in group B (44.5 ± 4.8 vs. 39.5 ± 3.7, p = 0.007). The plate length significantly differed between the groups. Twelve of 19 (63%) patients in group B received short-hole plates (six holes), while nine of ten (90%) patients in group A received long-hole plates (eight holes). In the multivariable analysis, the lateral body length of the distal humerus (p = 0.047, odds ratio = 0.734, 95% confidence interval: 0.542-0.996) and plate length (p = 0.036, odds ratio = 0.076, 95% confidence interval: 0.542-0.996) were associated with hardware-related complications. CONCLUSIONS Most patients developed hardware-related complications, particularly with short plates, mainly because of the narrow lateral body length of the distal humerus. Surgeons should be careful to secure EADHP in the appropriate position, especially when short plates are used in patients with narrow lateral body length.
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Affiliation(s)
- Hyoung-Seok Jung
- Department of Orthopaedic Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Yoo-Sun Won
- Department of Orthopaedic Surgery, Hospital of Chung-Ang University of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, Korea
| | - Yang-Seon Choi
- Department of Orthopaedic Surgery, Hospital of Chung-Ang University of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, Korea
| | - Jae-Sung Lee
- Department of Orthopaedic Surgery, Hospital of Chung-Ang University of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, Korea.
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Yokoyama H, Takegami Y, Tokutake K, Oshika Y, Iwase K, Tanaka K, Kanemura T, Imagama S. Clinical comparison of double-plate fixation by the perpendicular plate method versus parallel plate method for distal humeral fracture: a multicenter (TRON group) study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03462-1. [PMID: 36527504 DOI: 10.1007/s00590-022-03462-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Double-plating methods are popular, with perpendicular and parallel plate methods being widely used surgical method for the rigid fixation of distal humeral fracture (DHF). However, which plate method is better for DHF remains controversial. The aim of this study was to compare patient outcomes including the incidences of complications and reoperation between the two plate methods. METHODS We extracted 383 patients with DHF undergoing surgery between 2011 and 2020 from our multicenter database, which is named TRON. We divided the subjects into two groups: perpendicular plating group (Group A) and parallel plating group (Group B). To adjust for baseline differences between the groups, patients were matched for age, sex, olecranon osteotomy, AO type, and type of injury. We assessed the Mayo Elbow Performance Score (MEPS) at 3 and 6 months and the last follow-up month as the clinical outcome. We investigated the incidences of complications and reoperations in both groups. RESULTS After matching, each group comprised 50 patients. There was no significant difference between Group A versus Group B in MEPS score at each time point. The incidence of implant removal in Group B was higher than that in Group A (26.5% vs 50%, p = 0.023). DISCUSSION Although there were no significant differences in clinical outcomes or complications between the two groups, the incidence of implant removal was higher in Group B than in Group A. In the parallel plate technique, where the plates have to be placed in areas with thin subcutaneous soft tissue, the incidence of implant removal might be high due to the discomfort caused by the implant.
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Affiliation(s)
- Hiroki Yokoyama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasutaka Oshika
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kenya Iwase
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kohei Tanaka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Mao JT, Chang HW, Lin TL, Lin IH, Lin CY, Hsu CJ. Clinical Outcomes of Single Versus Double Plating in Distal-Third Humeral Fractures Caused by Arm Wrestling: A Retrospective Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111654. [PMID: 36422193 PMCID: PMC9697561 DOI: 10.3390/medicina58111654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Arm wrestling is a simple and popular activity among young people that causes distal-third humeral fractures. However, injury to the young population may cause economic loss; therefore, they need to return to work as soon as possible. Accordingly, we aimed to compare radiological and functional outcomes of distal-third humeral fractures caused by arm wrestling treated with double and single plating. Materials and Methods: Thirty-four patients with distal-third humeral fractures caused by arm wrestling were treated between January 2015 and January 2021. They were separated into double- and single-plating groups and treated using a triceps-sparing approach. Regular follow-up was performed to evaluate elbow functionality, range of motion, bone union, and complications; the American Shoulder and Elbow Surgeons score was used for functional assessment. Results: Patients treated with single plating exhibited union rate, union time, and elbow range of motion similar to those of patients treated with double plating; however, they exhibited better pain and functional outcomes (American Shoulder and Elbow Surgeons score) at 2 weeks, 1 month, and 3 months postoperatively (84.50 ± 5.01 vs. 61.70 ± 12.53 at 2 weeks, 96.20 ± 2.63 vs. 84.25 ± 14.56 at 1 month, and 100.00 vs. 94.76 ± 9.71 at 3 months, p < 0.05). The two groups exhibited no significant differences after 1 year (100.00 vs. 98.54 ± 3.99, p < 0.13). The overall complication rate was significantly higher in patients treated with double plating than in those treated with single plating (18.75% vs. 5.56%). Radial nerve palsy was observed in patients in both groups. Conclusions: In patients with distal-third humeral fractures caused by arm wrestling, single plating provides a union rate and elbow range of motion similar to those of double plating, with significantly fewer complications and lower surgical time and blood loss with improved early functional outcomes.
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Affiliation(s)
- Jui-Ting Mao
- Department of Orthopaedics, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan
| | - Hao-Wei Chang
- Department of Orthopaedics, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan
| | - Tsung-Li Lin
- Department of Orthopaedics, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung 40447, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40447, Taiwan
| | - I-Hao Lin
- Department of Orthopaedics, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan
| | - Chia-Yu Lin
- Department of Orthopaedics, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan
- Spine Center, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan
- Correspondence: (C.-Y.L.); (C.-J.H.)
| | - Chin-Jung Hsu
- Department of Orthopaedics, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan
- School of Chinese Medicine, China Medical University, Taichung 40447, Taiwan
- Correspondence: (C.-Y.L.); (C.-J.H.)
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Daoub A, Ferreira PMO, Cheruvu S, Walker M, Gibson W, Orfanos G, Singh R. Humeral Shaft Fractures: A Literature Review on Current Treatment Methods. Open Orthop J 2022. [DOI: 10.2174/18743250-v16-e2112091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
In this review, we aim to provide a concise yet comprehensive summation of the assessment and management of humeral shaft fractures. These are uncommon but prevalent enough that they are part of any trauma surgeon's scope of practice. They have historically been treated using non-operative methods, including braces and casts, supported by published excellent results in the rate of the bone union. However, recently published studies challenge these results and suggest the outcomes might be better with surgery, but the complications of an operation such as infection and nerve injury can not be overlooked. In summary, non-surgical treatment is still the gold standard in the treatment of these fractures, but the indications for surgical management are now clearer and include early signs of delayed union and patients who are unable to have a brace fitted or are uncompliant. It is likely that these new developments will start to change practice, and therefore the treatment of humeral shaft fractures should be a topic of interest of any clinician who deals with them.
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Li W, Li H, Wang H, Wang S. Ultrasound-guided preoperative localization of radial nerve in the treatment of extra-articular distal humeral shaft fractures. BMC Musculoskelet Disord 2022; 23:1. [PMID: 34980067 PMCID: PMC8725401 DOI: 10.1186/s12891-021-04954-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/08/2021] [Indexed: 01/13/2023] Open
Abstract
Background The aim of this study was to discuss the treatment of extra-articular distal humeral shaft fractures using ultrasound-guided preoperative localization of radial nerve. Methods Between May 2010 and December 2019, 56 patients with extra-articular distal humeral shaft fractures were retrospectively reviewed. Twenty eight patients were received examination by using preoperative localization of radial nerve guided by ultrasound-guided preoperative localization (group A) and 28 control patients without ultrasound-guided (group B). All patients were treated surgically for distal humeral shaft fractures by posterior approach techniques. Operative time, radial nerve exposure time, intraoperative bleeding volume, union time and iatrogenic radial nerve palsy rate were compared between the two groups. Elbow function was also evaluated using the Mayo Elbow Performance Score (MEPS). Results A significant difference was observed between the two groups, Operative time (113.25 min vs 135.86 min) (P < 0.001), radial nerve exposure time (20.82 min vs 32.53 min) (P < 0.001), intraoperative bleeding volume (246.80 ml vs 335.52 ml) (P < 0.001). However, iatrogenic radial nerve palsy rate (3.6% vs 7.1%) (P = 0.129), the fracture union time (13.52 months vs 12.96 months) (P = 0.796) and the MEPS score (87.56 vs 86.38) (P = 0.594) were no significantly different in both groups. Conclusions The study demonstrates that ultrasound-guided preoperative localization is an effective approach in the treatment of extra-articular distal humeral shaft fracture by revealing radial nerve, which may help reduce the operative time, radial nerve exposure time and the intraoperative bleeding volume.
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Affiliation(s)
- Weifeng Li
- Department of Orthopaedic Surgery, Baoding No 1 Central Hospital, No. 320, Changcheng Street, Baoding, 071000, Hebei, People's Republic of China
| | - Hui Li
- Department of Orthopaedic Surgery, Baoding No 1 Central Hospital, No. 320, Changcheng Street, Baoding, 071000, Hebei, People's Republic of China
| | - Haiying Wang
- Department of Orthopaedic Surgery, Baoding No 1 Central Hospital, No. 320, Changcheng Street, Baoding, 071000, Hebei, People's Republic of China
| | - Shunyi Wang
- Department of Orthopaedic Surgery, Baoding No 1 Central Hospital, No. 320, Changcheng Street, Baoding, 071000, Hebei, People's Republic of China.
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Lim JR, Yoon TH, Choi YR, Lee HM, Chun YM. Biomechanical evaluation of a modified proximal humeral locking plate application for distal extra-articular diaphyseal humeral fractures. J Orthop Res 2021; 39:1877-1883. [PMID: 33222233 DOI: 10.1002/jor.24925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/20/2020] [Accepted: 11/19/2020] [Indexed: 02/04/2023]
Abstract
The extra-articular distal humerus locking plate (EADHP) is widely used for distal extra-articular diaphyseal humeral fracture fixation. However, it occasionally causes skin prominence and discomfort. The upside-down use of a proximal humerus internal locking system (PHILOS) plate is suggested as an alternative option, but it lacks biomechanical evidence. The purpose of this study was to compare the biomechanical performance between two different fixation methods: the modified use of the PHILOS plate on the anterior cortex versus conventional use of an EADHP on the posterior cortex. Twelve pairs of fresh-frozen cadaveric humeri were used and 7 mm gap osteotomy was performed at 50 mm proximal to the lateral epicondyle to simulate an AO/OTA 12-C1.3 fracture type. Single load to failure was measured after five stiffness tests of the plate-bone constructs in anterior/posterior bending, internal/external torsion, and axial compression. There were no significant differences in metrics between the two groups, except for the load to failure in posterior bending, which was significantly higher for PHILOS (1589.3 ± 234.5) compared to EADHP (1430.1 ± 188.6), p < .023. In conclusion, the modified use of the PHILOS plate showed comparable biomechanical performance compared to the conventional EADHP. The new fixation method offers potential clinical advantages, considering the patient's position and surgical approach at the time of surgery as well as postoperative soft tissue irritation. Therefore, this could be an option for distal humeral extra-articular diaphyseal fracture fixation when the use of EADHP is not suitable or preferred.
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Affiliation(s)
- Joon-Ryul Lim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Tae-Hwan Yoon
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Yun-Rak Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Hwan-Mo Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
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Lim JR, Yoon TH, Lee HM, Chun YM. Anatomic fit of precontoured extra-articular distal humeral locking plates: a cadaveric study. Clin Shoulder Elb 2021; 24:66-71. [PMID: 34078013 PMCID: PMC8181839 DOI: 10.5397/cise.2021.00227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022] Open
Abstract
Background Extra-articular distal humerus locking plates (EADHPs) are precontoured anatomical plates widely used to repair distal humeral extra-articular diaphyseal fractures. However, EADHPs frequently cause distal protrusion and resulting skin discomfort. The purpose of this study was to predict the occurrence of anatomic fit mismatch. We hypothesized that the smaller the humerus size, the greater the anatomic fit mismatch with EADHP. Methods Twenty humeri were analyzed in this study. Humeral length and distal humeral width were used as parameters of humeral size. Plate protrusion was measured between the EADHP distal tip and the distal humerus. We set the level of unacceptable EADHP anatomic fit mismatch as ≥10 mm plate protrusion. Results A significant negative linear correlation was also confirmed between humeral size and plate protrusion, with a coefficient of determination of 0.477 for humeral length and 0.814 for distal humeral width. The cutoff value of humeral length to avoid ≥10 mm plate protrusion was 293.6 mm (sensitivity, 88.9%; specificity, 81.8%) and for distal humeral width was 60.5 mm (sensitivity, 100%; specificity, 81.8%). Conclusions Anatomic fit mismatch in distal humeral fractures after EADHP fixation has a negative linear correlation with humeral length and distal humeral width. For patients with a distal humeral width <60.5 mm, ≥10 mm plate protrusion will occur when an EADHP is used, and an alternative implant or approach should be considered.
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Affiliation(s)
- Joon-Ryul Lim
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hwan Yoon
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hwan-Mo Lee
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Min Chun
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Huang Q, Lu Y, Wang ZM, Sun L, Ma T, Wang Q, Li M, Liu HL, Hou MM, Xue HZ, Zhang K, Li Z. Anterolateral approach with two incisions versus posterior median approach in the treatment of middle- and distal-third humeral shaft fractures. J Orthop Surg Res 2021; 16:197. [PMID: 33731159 PMCID: PMC7967943 DOI: 10.1186/s13018-021-02355-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/10/2021] [Indexed: 11/24/2022] Open
Abstract
Background The surgical approaches remain controversial for the treatment of middle and distal-third humeral shaft (MDTHS) fractures. This study compared clinical effects of the anterolateral approach with two incisions (AATI) and the posterior median approach (PMA) in the treatment of MDTHS fractures. Methods A retrospective analysis was carried out. One hundred sixty-six patients with MDTHS fractures were selected from January 2015 to January 2017 in Xi’an Hong Hui Hospital. According to surgical approaches, patients were divided into AATI (86 cases) and PMA group (80 cases). All patients were treated with open reduction and plate fixation. Operation indexes were compared, including incision length, operation time, and bleeding. Bryan-Morrey score was used to evaluate elbow joint function. Complication incidence was compared, such as incision infection, iatrogenic radial nerve injury, and nonunion. Results The AATI group showed smaller incision length, less bleeding, lower iatrogenic radial nerve injury rate, and better elbow function than that of PMA group (P<0.05). Conclusions The middle and distal-third humeral shaft fractures can be successfully cured by both approaches. Compared with the posterior median approach, it has better clinical effects of the anterolateral approach with two incisions, which is worthy of clinical application and promotion.
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Affiliation(s)
- Qiang Huang
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Yao Lu
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Zhi Meng Wang
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Liang Sun
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Teng Ma
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Qian Wang
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Ming Li
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Hong Liang Liu
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Ming Ming Hou
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Han Zhong Xue
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Kun Zhang
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China.
| | - Zhong Li
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China.
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Long dorsal "Y-shaped" plate for distal diaphyseal humeral fractures. INTERNATIONAL ORTHOPAEDICS 2021; 45:1309-1314. [PMID: 33590258 DOI: 10.1007/s00264-021-04969-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Osteosynthesis of distal diaphyseal humeral fractures is challenging, especially if there is a metaphyseal extension of the fracture line with a butterfly third fragment or if the fracture is bifocal. These fractures put the radial nerve at risk at the time of the fracture and during surgery. We hypothesize that ORIF with a long dorsal Y-plate matching the dorsal aspects of the humeral diaphysis and of the two metaphyseal columns would provide a reliable method of fixation for distal diaphyseal humeral fractures even when there is a metaphyseal extension or bifocal component. METHODS Between 2015 and 2019, 17 distal diaphyseal humeral fractures in 17 consecutive patients (14 men, 3 women, mean age 38 years) were operated on with a long "Y-shaped" dorsal plate. There were two bifocal fractures and 11 diaphyso-metaphyseal fractures with butterfly fragments. All 17 patients could be retrospectively followed up clinically and radiographically at a mean follow-up of 25 months (min 4, max 40). Clinical charts included VAS pain, elbow range of motion, QuickDASH, MEPS and subjective elbow value. RESULTS Bone healing was observed in all cases. Five patients (29%) had a pre-operative radial nerve palsy. All pre-operative radial nerve palsies but one recovered spontaneously. One complete radial nerve palsy that was not present before the operation was observed after surgery. It recovered spontaneously in four months. One case of post-operative elbow stiffness required a revision. Only one case (5%) showing a complication directly related to the plate (secondary displacement) required revision. Mean post-operative elbow flexion was 134°. Extension deficit averaged 13°. Subjective elbow value, QuickDASH and MEPS averaged respectively 81%, 19 points and 92 points. DISCUSSION Currently available plates (long dorsal straight, short dorsal "Y-shaped", long lateral) may have limitations in terms of screw purchase or biomechanical efficiency when ORIF of distal diaphyseal humeral fractures is considered. A long dorsal "Y-shaped" plate is a new alternative which may be successfully used even in the most difficult cases. CONCLUSION Our study suggests that a long dorsal "Y-shaped" plate is suitable for distal diaphyseal humeral fractures especially when there is a metaphyseal bifocal or third fragment component.
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Thorat B, Singh A, Vohra R, Arshad M, Mavani R. Modified application of distal medial tibial locking plate as an alternative for fixation of an extraarticular distal-third diaphyseal humerus fracture. Trauma Case Rep 2021; 34:100420. [PMID: 34150977 PMCID: PMC8192697 DOI: 10.1016/j.tcr.2021.100420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Surgical management of Extraarticular Distal-third diaphyseal Humerus Fracture (EADHF) poses a dilemma in terms of surgical approach, implant selection and position of the implant due to the availability of various pre-contoured implants and plate configurations. Various studies have described a modified application of anatomic locking plates as a satisfactory method of fixation in the surgical management of EADHF. Case presentation This report discusses the modified application of anatomic Distal Medial Tibial locking Plate (DMTP) as an alternative strategy in fixation of an acute extraarticular distal-third diaphyseal fracture of the humerus in a 45-years-old female patient. Bony union was achieved successfully without any malalignment and the patient showed a full recovery with an excellent clinical and outcome at 2-years follow-up. Conclusion In EADHF, the use of 3.5 mm DMTP is advantageous as it offers rigid fixation by insertion of more number of 3.5 mm locking bicortical screws and stability in both columns. This promotes biological fracture healing, low rate of complication, early return to work with improvement in clinical function. Therefore, we recommend that pre-contoured 3.5 mm DMTP can be successfully used as an alternative fixation choice for the treatment of EADHF.
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Affiliation(s)
- Babaji Thorat
- Department of Orthopaedic Surgery, Amandeep Hospital, Amritsar, India
| | - Avtar Singh
- Department of Orthopaedic Surgery, Amandeep Hospital, Amritsar, India
| | - Rajeev Vohra
- Department of Orthopaedic Surgery, Amandeep Hospital, Amritsar, India
| | - Mohammad Arshad
- Department of Orthopaedic Surgery, Amandeep Hospital, Amritsar, India
| | - Ravi Mavani
- Department of Orthopaedic Surgery, Amandeep Hospital, Amritsar, India
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Abstract
OBJECTIVE To determine if surgical approach impacts the rate of nerve palsy after plate fixation of humerus shaft fractures and whether or not iatrogenic nerve palsy recovers in similar ways to preoperative palsy. DESIGN Retrospective. SETTING Two trauma centers. PATIENTS Patients 18+ years of age with nonpathologic, extra-articular humerus shaft fractures (OTA/AO 12A/B/C and 13A2-3) treated with plate fixation. INTERVENTION Plate fixation of humerus shaft fractures, from 2008 to 2016. MAIN OUTCOME MEASUREMENT Rate of iatrogenic nerve palsy by a surgical approach and injury characteristics. RESULTS Two hundred sixty-one humeral shaft fractures were included. The rate of preoperative palsy was 19%. Radial nerve palsy (RNP) was present in 18%. Iatrogenic RNP occurred in 12.2% and iatrogenic ulnar palsy in 1.2%. Iatrogenic palsy occurred in 15.6% of middle and 15% of distal fractures, with fracture location significantly different in those developing RNP (P = 0.009). Iatrogenic RNP occurred in 7.1% of anterolateral, 11.7% of posterior triceps-splitting, and 17.9% of posterior triceps-sparing approaches (P = 0.11). Follow-up data were available for 139 patients at an average of 12 months. Preoperative RNP resolved less often than iatrogenic RNP, in 74% versus 95% (P = 0.06). Time to resolution was longer for preoperative RNP, at 5.5 versus 4.1 months (P = 0.91). Twenty-two percent with preoperative RNP underwent tendon transfer or wrist fusion, versus 0% after iatrogenic RNP (P = 0.006). CONCLUSION Iatrogenic RNP is not uncommon with humeral fracture fixation and occurs at similar rates in anterior and posterior approaches and with midshaft and distal fractures. Iatrogenic RNP had a high rate of recovery. Preoperative RNP more often requires surgery for unresolved palsy. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Yorukoglu AC, Demirkan AF, Buker N. Distal medial tibial locking plate for fixation of extraarticular distal humeral fractures; an alternative choice for fixation. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:294-298. [PMID: 29735339 PMCID: PMC6150447 DOI: 10.1016/j.aott.2018.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 01/17/2018] [Accepted: 02/26/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to describe an alternative fixation method for distal humeral extra-articular fractures through posterior approach using distal tibia anatomic locking plate; and to evaluate the patient's functional outcome and union condition. METHODS Eighteen patients (11 men and 7 women; average age of 37.0 ± 17.3 years (range: 18-73 years)) with a distal humeral extra-articular fracture who were treated with distal tibial medial locking plate were included into the study. The mean follow up time was 36.2 ± 16.7 (12-57) months. Functional results were evaluated with perception of pain, range of joint motion, grasp and pinch strengths. RESULTS Union was achieved in 17 of 18 patients. Only one patient had non-union due to infection and underwent debridement. The mean time for union was 7.8 ± 5.9 months (2-20). Patient perception of pain was X = 1.88 ± 2.50 and X = 4.55 ± 2.68, respectively, at rest and activity. The active ranges of joint motion were adequate for functional use. General functional state of affected extremity (DASH-T) was perfect (X = 27.14 ± 25.66), the performance of elbow joint was good (X = 84.44 ± 11.57). There were no differences in the comparison of grasp and pinch grip of patients with uninvolved extremity (p > 0.05). CONCLUSIONS In distal humeral extra-articular fractures, use of distal medial tibia plate has advantages such as providing high rates for union, low rates for complication, and early return to work with early rehabilitation, therefore it may be considered a fixation choice that can be used for distal humeral extra-articular fractures. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Ali Cagdas Yorukoglu
- Pamukkale University, Faculty of Medicine, Department of Orthopedics and Traumatology, Pamukkale, Denizli, Turkey.
| | - Ahmet Fahir Demirkan
- Pamukkale University, Faculty of Medicine, Department of Orthopedics and Traumatology, Pamukkale, Denizli, Turkey.
| | - Nihal Buker
- Pamukkale University, School of Physical Therapy and Rehabilitation, Pamukkale, Denizli, Turkey.
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Trikha V, Agrawal P, Das S, Gaba S, Kumar A. Functional outcome of extra-articular distal humerus fracture fixation using a single locking plate: A retrospective study. J Orthop Surg (Hong Kong) 2018; 25:2309499017727948. [PMID: 28844197 DOI: 10.1177/2309499017727948] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The optimal method for fixation of extra-articular distal humerus factures poses a management dilemma. Although various plate configurations have been proposed, anatomic shaped extra-articular distal humerus locking plates have emerged as a viable solution for these complex injuries. We assessed clinico-radiologic outcome in our retrospective case series of extra-articular distal humerus fractures managed with these plates. METHODS Forty-five patients of extra-articular distal humerus fractures, who were operated at our level 1 trauma centre between January, 2012 and December, 2016, were identified. After exclusion, 36 patients were available for the final assessment. All patients were operated with the triceps-reflecting modified posterior approach. Regular clinico-radiologic follow-up was done evaluating elbow functionality, fracture union, secondary displacement, non-union, implant failure and any complications; Mayo Elbow Performance score (MEPS) was used for the final functional assessment. RESULTS Twenty-four (66.7%) male and 12 (33.3%) female patients constituted the study group, who had an average follow-up of 15 months. Preoperatively three patients and post-operatively one patient had radial nerve palsy; all had neurapraxia and recovered completely. Overall, 34 (94.4%) patients were adjudged to have complete radiological union within 3 months; 2 (5.5%) patients developed non-union. Mean flexion achieved was 122.9° ± 23°, and mean extension was -4.03° ± 6.5°; 1 patient with head injury developed flexion deformity of 45°. Average MEPS at the final follow-up was 90.8° ± 9.9°. CONCLUSION Stable reconstruction and early initiation of physiotherapy are utilitarian to envision optimal outcome; the use of precontoured extra-articular distal humerus locking plates has yielded satisfactory results with minimal complications in our hands.
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Affiliation(s)
- Vivek Trikha
- JPN Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Prabhat Agrawal
- JPN Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Saubhik Das
- JPN Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sahil Gaba
- JPN Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Arvind Kumar
- JPN Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Ayoub MS, Tarkin IS. Best care paradigm to optimize functionality after extra-articular distal humeral fractures in the young patient. J Clin Orthop Trauma 2018; 9:S116-S122. [PMID: 29628712 PMCID: PMC5883908 DOI: 10.1016/j.jcot.2018.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 02/03/2018] [Indexed: 12/27/2022] Open
Abstract
For younger patients with extra-articular distal humerus fractures closed management is plagued with high rates of malunion, suboptimal functional outcomes, extended immobilization with loss of early motion, a delay in return to work, and a general period of lost productivity. Surgical management offers an appealing alternative. Maintaining respect for the triceps musculature and minimizing iatrogenic injury to the radial nerve are primary concerns with operative treatment. Accordingly, use of a triceps-sparing approach and single column plating may be the optimal treatment paradigm in the young patient presenting with an extra-articular distal humerus fracture.
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Affiliation(s)
- Mark S. Ayoub
- UCSF-Fresno, Department of Orthopaedic Surgery, 2823 Fresno Street, Fresno, CA 93721, United States,Corresponding author.
| | - Ivan S. Tarkin
- University of Pittsburgh Medical Center, Department of Orthopaedic Surgery, Kaufmann Medical Building, 3471 5th Avenue, Suite 1010, Pittsburgh, PA 15213, United States
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Lee HM, Kim YS, Kang S, Lee MY, Kim JP. Modified anterolateral approach for internal fixation of Holstein-Lewis humeral shaft fractures. J Orthop Sci 2018; 23:137-143. [PMID: 29103824 DOI: 10.1016/j.jos.2017.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 08/08/2017] [Accepted: 10/12/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND The authors modified the anterolateral approach for Holstein-Lewis humeral shaft fractures using a plating technique to achieve sufficient distal fixation by minimal splitting of the brachioradialis muscle to fix the most distal screws. The purpose of this retrospective study was to evaluate the efficacy of our modified anterolateral approach for Holstein-Lewis humeral fractures and document clinical and functional results. MATERIALS AND METHODS Between 2008 and 2014, 18 patients (mean age 35.4 years) with a Holstein-Lewis humeral shaft fracture who underwent open reduction and internal fixation with a plate and screws using the modified anterolateral approach and followed for a minimum of 12 months were included. Radiologic fracture configurations, number of distal cortical fixations, union rate, and time to union were analyzed. Clinical outcomes were evaluated using the Mayo elbow performance index system, range of elbow motion, and postoperative complications. RESULTS Mean fracture length was 60.2 ± 10.2 mm (range 49.2-77.2) and mean distal cortical length was 41.4 ± 7.04 mm (range 22.8-59.6). Distal fragments were fixed at a minimum of six cortical points (range 6-8) in all cases using the modified anterolateral approach. Average time to union was 10.5 weeks (range 8-12 weeks). All cases of radial nerve palsy completely recovered within 3 months. Mean elbow range of motion at final follow-up was 3.2 degrees of flexion contracture (range 0-10) and 135.4 degrees of further flexion (range 120-140), and the average Mayo elbow performance score was 96.3 points (range 90-100). There were no non-union or metal failures. CONCLUSIONS The results obtained indicate that the modified anterolateral approach is a safe and easy accessible method that provides sufficient distal osseous fixation for Holstein-Lewis humeral shaft fractures without serious complications. The modified anterolateral approach for plate osteosynthesis appears to be one of the most available options for the treatment of Holstein-Lewis humeral fractures. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Ho Min Lee
- Department of Orthopaedic Surgery, College of Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Young Sung Kim
- Department of Orthopaedic Surgery, College of Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Suk Kang
- Department of Orthopaedic Surgery, College of Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Min Young Lee
- Department of Orthopaedic Surgery, College of Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Jong Pil Kim
- Department of Orthopaedic Surgery, College of Medicine, Dongguk University, Gyeongju, Republic of Korea.
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Zhao W, Qu W, Fu C, Jiang H, Liu S, Cheng C. Antero-lateral minimally invasive plate osteosynthesis (MIPO) with the radial nerve exploration for extra-articular distal-third diaphyseal fractures of the humerus. INTERNATIONAL ORTHOPAEDICS 2017; 41:1757-1762. [PMID: 28577034 DOI: 10.1007/s00264-017-3514-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/11/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Traditional open reduction and internal fixation (ORIF) of extra-articular distal humerus fractures has a risk of iatrogenic radial nerve injury, extensive soft tissue stripping, and long incision scar. We performed an antero-lateral minimally invasive plate osteosynthesis (MIPO) technique with the radial nerve exploration for distal-third diaphyseal fractures of the humerus and evaluated clinical and radiographic outcomes through this respective study. METHODS From April 2010 to June 2016, 28 cases of extra-articular distal-third diaphyseal fractures were treated with an antero-lateral MIPO procedure. Patient demographics, Disabilities of the Arm, Shoulder and Hand (DASH) Score, Mayo Elbow Performance (MEP) Score, elbow range of motion, scars and post-operative complications were recorded and analyzed. RESULTS All fractures were united with a mean time of 3.5 months. One patient exhibited delayed union (3.6%). The mean DASH Score was 6.6, and all patients had excellent or good MEP Score values. The average scar length was 6.8 cm, and the shortest was 4.5 cm. CONCLUSIONS The MIPO technique via an antero-lateral approach for extra-articular distal-third diaphyseal fractures of the humerus results in satisfactory clinical outcomes. LEVEL OF EVIDENCE Level IV, case series, treatment study.
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Affiliation(s)
- Wei Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Street, Dalian, Liaoning, 116011, China
| | - Wei Qu
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Street, Dalian, Liaoning, 116011, China.
| | - Chongyang Fu
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Street, Dalian, Liaoning, 116011, China
| | - Huajun Jiang
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Street, Dalian, Liaoning, 116011, China
| | - Sida Liu
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Street, Dalian, Liaoning, 116011, China
| | - Chao Cheng
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Street, Dalian, Liaoning, 116011, China
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The triceps-sparing posterior approach to plating humeral shaft fractures results in a high rate of union and low incidence of complications. Arch Orthop Trauma Surg 2016; 136:1683-1689. [PMID: 27744633 DOI: 10.1007/s00402-016-2578-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The optimal treatment of humeral shaft fractures continues to be debated. In the current investigation, we sought to determine the clinical and radiographic outcomes following the plate fixation of humeral shaft fractures utilizing the triceps-sparing posterior approach. MATERIALS AND METHODS A retrospective review identified a consecutive series of 66 humeral shaft fractures (OTA 12-A, 12-B, or 12-C) treated with dual plate fixation via a posterior, triceps-sparing approach between 2005 and 2014 by a single surgeon. Demographics, operative reports, clinical follow-up, and preoperative radiographs were reviewed. Postoperative radiographs were assessed for angular deformity and time to union. Range of motion and strength testing were also reviewed. RESULTS A total of 66 humeral shaft fractures were reviewed with a mean clinical follow-up of 8.0 months. The mean time to union was 15.6 ± 11.1 weeks, and there was one case of delayed union. Seventeen of 66 (25.8 %) patients presented with a primary radial nerve palsy following injury, and 14 of the 17 (82 %) of the preoperative radial nerve palsies fully resolved at an average of 31 weeks following injury. Two additional patients developed radial nerve palsies postoperatively (3.0 %). CONCLUSION This is a large consecutive series of humeral shaft fractures treated with plating through a posterior approach by a single surgeon. The triceps-sparing posterior approach to the humerus results in high union rates and a low incidence of secondary radial nerve palsy. LEVEL OF EVIDENCE Level IV, Case Series.
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Kharbanda Y, Tanwar YS, Srivastava V, Birla V, Rajput A, Pandit R. Retrospective analysis of extra-articular distal humerus shaft fractures treated with the use of pre-contoured lateral column metaphyseal LCP by triceps-sparing posterolateral approach. Strategies Trauma Limb Reconstr 2016; 12:1-9. [PMID: 27812778 PMCID: PMC5360669 DOI: 10.1007/s11751-016-0270-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/21/2016] [Indexed: 11/27/2022] Open
Abstract
Management of extra-articular distal humerus fractures presents a challenge to the treating surgeon due to the complex anatomy of the distal part of the humerus and complicated fracture morphology. Although surgical treatment has shown to provide a more stable reduction and alignment and predictable return to function, it has been associated with complications like iatrogenic radial nerve palsy, infection, non-union and Implant failure. We in the present series retrospectively analysed 20 patients with extra-articular distal humerus shaft fractures surgically treated using the extra-articular distal humeral locking plate approached by the triceps-sparing posterolateral approach. The outcome was assessed using the DASH score, range of motion at the elbow and the time to union. The mean time to radiographic fracture union was 12 weeks.
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Affiliation(s)
- Yatinder Kharbanda
- Department of Orthopedics, Apollo Hospital, HNo299, Pocket B, DDA Flats, Sarita Vihar, New Delhi, Delhi, 110076, India
| | - Yashwant Singh Tanwar
- Department of Orthopedics, Apollo Hospital, HNo299, Pocket B, DDA Flats, Sarita Vihar, New Delhi, Delhi, 110076, India.
| | - Vishal Srivastava
- Department of Orthopedics, Dr. RML Hospital and PGIMER, New Delhi, Delhi, 110001, India
| | - Vikas Birla
- Department of Orthopedics, Apollo Hospital, HNo299, Pocket B, DDA Flats, Sarita Vihar, New Delhi, Delhi, 110076, India
| | - Ashok Rajput
- Department of Orthopedics, Dr. RML Hospital and PGIMER, New Delhi, Delhi, 110001, India
| | - Ramsagar Pandit
- Department of Orthopedics, Apollo Hospital, HNo299, Pocket B, DDA Flats, Sarita Vihar, New Delhi, Delhi, 110076, India
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19
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Cadaveric investigation on radial nerve strain using different posterior surgical exposures for extraarticular distal humeral ORIF: merits of nerve decompression through a lateral paratricipital exposure. J Orthop Trauma 2015; 29:e43-5. [PMID: 25050751 DOI: 10.1097/bot.0000000000000204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether the type of posterior surgical approach for distal humeral fracture open reduction and internal fixation influenced radial nerve strain during simulated operative retraction in a cadaveric model. METHODS Three different posterior surgical exposures: triceps splitting, lateral paratricipital, and paratricipital with release of the lateral intermuscular septum were used. Radial nerve strain was measured using a microDVRT, while traction was applied with a digital force gauge at forces 0.1-0.3 kg. RESULTS The lateral paratricipital with nerve decompression was superior to both the triceps splitting approach (P < 0.048) and paratricipital method without decompression (P < 0.036). There was no significant difference between the triceps splitting method and paratricipital exposure without intermuscular septum release. CONCLUSIONS Radial nerve decompression through release of the lateral intermuscular septum through a lateral paratricipital exposure ideally decreases nerve strain during humeral open reduction and internal fixation in our cadaveric model.
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Scolaro JA, Hsu JE, Svach DJ, Mehta S. Plate selection for fixation of extra-articular distal humerus fractures: a biomechanical comparison of three different implants. Injury 2014; 45:2040-4. [PMID: 25249244 DOI: 10.1016/j.injury.2014.08.036] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/11/2014] [Accepted: 08/17/2014] [Indexed: 02/02/2023]
Abstract
Operative fixation of extra-articular distal humerus using a single posterolateral column plate has been described but the biomechanical properties or limits of this technique is undefined. The purpose of this study was to evaluate the mechanical properties of distal humerus fracture fixation using three standard fixation constructs. Two equal groups were created from forty sawbones humeri. Osteotomies were created at 80mm or 50mm from the tip of the trochlea. In the proximal osteotomy group, sawbones were fixed with an 8-hole 3.5mm LCP or with a 6-hole posterolateral plate. In the distal group, sawbones were fixed with 9-hole medial and lateral 3.5mm distal humerus plates and ten sawbones were fixed with a 6-hole posterolateral plate. Biomechanical testing was performed using a servohydraulic testing machine. Testing in extension as well as internal and external rotation was performed. Destructive testing was also performed with failure being defined as hardware pullout, sawbone failure or cortical contact at the osteotomy. In the proximal osteotomy group, the average bending stiffness and torsional stiffness was significantly greater with the posterolateral plate than with the 3.5mm LCP. In the distal osteotomy group, the average bending stiffness and torsional stiffness was significantly greater with the posterolateral plate than the 3.5mm LCP. In extension testing, the yield strength was significantly greater with the posterolateral plate in the proximal osteotomy specimens, and the dual plating construct in the distal osteotomy specimens. The yield strength of specimens in axial torsion was significantly greater with the posterolateral plate in the proximal osteotomy specimens, and the dual plating construct in the distal osteotomy specimens. Limited biomechanical data to support the use of a pre-contoured posterolateral distal humerus LCP for fixation of extra-articular distal humerus exists. We have found that this implant provided significantly greater bending stiffness, torsional stiffness, and yield strength than a single 3.5mm LCP plate for osteotomies created 80mm from the trochlea. At the more distal osteotomy, dual plating was biomechanically superior. Our results suggest that single posterolateral column fixation of extra-articular humerus fractures is appropriate for more proximal fractures but that dual plate fixation is superior for more distal fractures.
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Affiliation(s)
- John A Scolaro
- University of California, Irvine, Department of Orthopaedic Surgery, 101 The City Drive South, Pavilion III, Building 29A, 2nd Floor, Orange, CA 92868, United States.
| | - Jason E Hsu
- University of Washington, Department of Orthopaedics and Sports Medicine, 4245 Roosevelt Way N.E., Seattle, WA 98105, United States
| | - David J Svach
- DePuy Synthes Mechanical Testing Laboratory, 1301 Goshen Parkway, West Chester, PA 19380, United States
| | - Samir Mehta
- University of Pennsylvania, Department of Orthopaedic Surgery, 3400 Spruce Street, 2 Silverstein Pavilion, Philadelphia, PA 19104, United States
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Illical EM, Farrell DJ, Siska PA, Evans AR, Gruen GS, Tarkin IS. Comparison of outcomes after triceps split versus sparing surgery for extra-articular distal humerus fractures. Injury 2014; 45:1545-8. [PMID: 24813383 DOI: 10.1016/j.injury.2014.04.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/27/2014] [Accepted: 04/07/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare elbow range of motion (ROM), triceps extension strength, and functional outcome of AO/OTA type A distal humerus fractures treated with a triceps-split or -sparing approach. DESIGN Retrospective review. SETTING Two level one trauma centres. PATIENTS Sixty adult distal humerus fractures (AO/OTA 13A2, 13A3) presenting between 2008 and 2012 were reviewed. Exclusion criteria removed 18 total patients from analysis and three patients died before final follow-up. INTERVENTION Patients were divided into two surgical approach groups chosen by the treating surgeon: triceps split (16 patients) or triceps sparing (23 patients). MAIN OUTCOME MEASUREMENTS Elbow ROM and triceps extension strength testing were completed in patients after fractures had healed. All patients were also given the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. RESULTS Compared to the triceps-split cohort, the triceps-sparing cohort had greater elbow flexion (sparing 143 ± 7° compared to split 130 ± 12°, p=0.03) and less extension contracture (sparing 6 ± 8° compared to split 23 ± 4°, p<0.0001). Triceps strength compared to the uninjured arm also favoured the triceps-sparing cohort (sparing 88.9 ± 28.3% compared to split 49.4 ± 17.0%, p=0.007). DASH scores were not statistically significant between the two cohorts (sparing 14.5 ± 12.2 compared to split 23.6 ± 22.3, p=0.333). CONCLUSIONS A triceps-sparing approach for surgical treatment of extra-articular distal humerus fractures can result in better elbow ROM and triceps strength than a triceps-splitting approach. Both approaches, however, result in reliable union and similar functional outcome. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Emmanuel M Illical
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Dana J Farrell
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Peter A Siska
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrew R Evans
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gary S Gruen
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ivan S Tarkin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Yin P, Zhang L, Mao Z, Zhao Y, Zhang Q, Tao S, Liang X, Zhang H, Lv H, Li T, Tang P. Comparison of lateral and posterior surgical approach in management of extra-articular distal humeral shaft fractures. Injury 2014; 45:1121-5. [PMID: 24685053 DOI: 10.1016/j.injury.2014.02.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/17/2014] [Accepted: 02/24/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this study was to compare treatment results and complication rates between lateral and posterior approaches in surgical treatment of extra-articular distal humeral shaft fractures. MATERIAL AND METHODS Between June 2008 and May 2012, a total of 68 patients with extra-articular distal humeral shaft fractures were treated by lateral and posterior approaches. Of the patients, 30 were operated by a lateral approach (group I) and 26 patients were operated by a posterior approach (group II). There was no statistical significance between the two groups in sex distribution, age, the mechanism of the injury, injured arms, AO/ASIF (Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation) classification, and the time from injury to surgery (P>0.05). Operation time, intraoperative bleeding volume, hospitalisation, clinical outcomes, and complications were compared between the two groups. The elbow functional results were evaluated by the Mayo Elbow Performance Score (MEPS). RESULTS All patients were followed up. The average of follow-up in group I was 15.53±2.636 months (range, 12-22 months), and was 16.12±2.889 months (range, 12-22 months) in group II. There was no significant difference in the operation time, intraoperative bleeding time, and hospitalisation between the two groups (P>0.05). In group I, the mean time of bone union was 12.87±1.852 weeks (range, 10-16 weeks), the mean degrees of elbow flexion was 139.20°±3.274° (range, 134-146°), the mean degrees of elbow extension was 4.77°±1.906° (range, 0-8°), and the mean points of MEPS was 87.00±7.724 (range, 70-100 points). In group II, the mean time of bone union was 12.96±2.218 weeks (range, 10-16 weeks), the mean degrees of elbow flexion was 137.85°±4.076° (range, 130-145°), the mean degrees of elbow extension was 5.15°±2.327° (range, 0-9°), and the mean points of MEPS was 86.15±7.656 (range, 70-100 points). There was no significant difference in the bone union, range of elbow flexion, range of elbow extension and MEPS between the two groups (P>0.05). The overall complication rate in group I was lower than that in group II (P=0.041). CONCLUSIONS Both lateral and posterior surgical approaches acquired satisfied treatment results in the management of extra-articular distal humeral shaft fractures, and there was a lower complication rate using the lateral approach.
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Affiliation(s)
- Peng Yin
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, PR China; Medical College, Nankai University, No. 94 Weijin Road, Tianjin 300071, PR China.
| | - Lihai Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, PR China
| | - Zhi Mao
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, PR China
| | - Yanpeng Zhao
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, PR China
| | - Qun Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, PR China
| | - Sheng Tao
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, PR China
| | - Xiangdang Liang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, PR China
| | - Hao Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, PR China
| | - Houchen Lv
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, PR China
| | - Tongtong Li
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, PR China; Medical College, Nankai University, No. 94 Weijin Road, Tianjin 300071, PR China
| | - Peifu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, PR China.
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Zhou Z, Tang Z, Zhao X, Chen W, Chen X, Mu M, Zhang S, Ning B, Jia T. Mismatch of AO anatomically shaped distal humeral plate with humeral shaft forward flexion angulation in adult Chinese population. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 24:1145-50. [PMID: 24659427 DOI: 10.1007/s00590-014-1431-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 02/19/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND LCP extra-articular distal humerus plate (LCPEA) designed by AO has been introduced as an anatomically shaped plate that improves the results of surgical fixation in extra-articular distal humeral shaft fractures. However, no study analyzed whether LCPEA matches humeral shaft forward flexion angulation (FFA). OBJECTIVE The aims of this study were to evaluate the morphological discrepancies between LCPEA and the humeral shaft FFA in Chinese cadaveric dried adult humeri and to propose a further design of pre-contoured plates to accommodate the FFA. MATERIALS AND METHODS Forty-four Chinese cadaveric dried adult humeri were used for this study. An eight-hole LCPEA was applied to the posterior aspect of the distal humerus according to the contour. Mismatches between the bone and the plate were recorded. The distance between the inner surface of the plate and the underlying humeral dorsal cortex was measured at the sites of mismatch. The humeral shaft FFA was measured from the intersection angle between tangent lines placed on the dorsal aspect of the 1/3 distal humeral shaft and the dorsal ridge of the 2/3 proximal humeral shaft. The location of the apex of the FFA was determined by measuring the distance from the most distal point of trochlea of humerus to the point of intersection of the FFA tangent lines. The distance was defined as forward flexion distance (FFD). RESULTS Mismatch was found at the level of proximal 3-6 holes of LCPEA with an average distance of 6.9 ± 3.1 mm (range 2.3-14.0 mm) at the tip of the plate. The FFA was present in all specimens. The average FFA was 8.2° ± 2.2° (range 4°-13°), the average FFD was 99.9 ± 9.6 mm (range 79.2-117.9 mm), and the average ratio of FFD to humerus length was 0.33 ± 0.03 (range 0.27-0.39). CONCLUSIONS A rather consistent pattern of mismatch was found at the proximal part of LCPEA. An attempt to fit the plate to the bone at this level may cause a gap of the fracture at the opposite cortex. The main reason for the mismatch is the existence of the humeral shaft FFA. LCPEA is usually made a bend of about 8° between the fourth and the fifth dynamic-compression portion of the combination hole in the distal-to-proximal direction.
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Affiliation(s)
- Zhiyong Zhou
- Department of Orthopaedic Surgery, Yantai Shan Hospital, 91# Jiefang Road, Yantai, 264000, Shandong, China,
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