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Ku KH, Baek JH, Lee YJ, Kim MS. Risk factors for nonunion in patients with transcondylar fracture of the distal humerus after open reduction and internal fixation. J Shoulder Elbow Surg 2024; 33:139-144. [PMID: 37633592 DOI: 10.1016/j.jse.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/12/2023] [Accepted: 07/21/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Transcondylar fractures have been reported to rarely occur in the distal humerus, and stable fixation is difficult because of the unique fracture pattern. However, few studies have reported the risk factors for nonunion after open reduction and internal fixation (ORIF). This study aimed to evaluate the demographic and surgical risk factors for nonunion in patients who had undergone ORIF for transcondylar fractures. METHODS We retrospectively reviewed 68 patients who underwent ORIF for transcondylar fractures. Preoperative demographic factors, including diabetes mellitus (DM) and smoking, and operative factors, including fixation methods (eg, dual plate/single plate/tension band wiring [TBW]) were assessed as risk factors for nonunion. RESULTS Nonunion occurred in 8 out of 68 patients (11.8%). Univariate analysis revealed that among the demographic factors, DM (4/8 [50%] vs. 8/60 [13.3%], P = .028) and smoking (3/8 [37.5%] vs. 4/60 [6.7%], P = .031) were significantly different between nonunion and union patients. Regarding operative factors, the fixation method (dual plate/single plate/TBW; 2 [25.0%]/2 [25.0%]/4 [50%] vs. 29 [48.3%]/25 [41.7%]/6 [10.0%], P = .033) showed significant differences between nonunion and union patients. Multivariate regression analysis showed that DM (odds ratio [OR], 10.560; 95% confidence interval [CI], 1.308-85.247; P = .027), smoking (OR 22.371; 95% CI, 2.111-237.081; P = .010), and TBW (OR 15.390; 95% CI, 1.348-175.666; P = .028) were independent risk factors for nonunion. CONCLUSIONS Nonunion occurred in approximately 12% of the patients who underwent ORIF in the transcondylar region of the distal humerus. The risk of nonunion was higher in patients with DM than those who smoked. In addition, among the fixation methods, the TBW technique was a significant risk factor for nonunion.
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Affiliation(s)
- Ki-Hyeok Ku
- Department of Orthopaedic Surgery, Shoulder & Elbow Clinic, School of Medicine, Kyung Hee University and Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jong-Hun Baek
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University and Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Young-Jik Lee
- Department of Orthopaedic Surgery, Shoulder & Elbow Clinic, School of Medicine, Kyung Hee University and Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Myung-Seo Kim
- Department of Orthopaedic Surgery, Shoulder & Elbow Clinic, School of Medicine, Kyung Hee University and Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
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Kim BS, Jung KJ, Kim KB, Park SS. Treating AO Type C2-3 Distal Humerus Fractures With the Anconeus Flap Transolecranon Approach. Orthopedics 2022; 45:e326-e334. [PMID: 35947456 DOI: 10.3928/01477447-20220805-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We evaluated the outcomes of precontoured locking plate fixation with the anconeus flap transolecranon (AFT) approach to treating AO type C2-3 comminuted intra-articular distal humerus (IDH) fractures among active patients. Thirty-six patients (age <65 years) with IDH fractures treated with precontoured distal humerus locking plate fixation were divided into 2 groups: group 1 (n=18; transolecranon [TO] approach) and group 2 (n=18; AFT approach). The radiographic examination included assessments of implant failure, fracture site union, and olecranon osteotomy site union. Clinical examination included assessments of operating time, range of motion (ROM), Mayo Elbow Performance Score (MEPS), Disability of the Arm, Shoulder and Hand (DASH) score, and complications. The mean follow-up time was 25.2 months (range, 18-79 months). The mean operating time was 134.3 minutes and was significantly longer for group 2 (AFT; 141.2 minutes) than for group 1 (TO; 124.2 minutes). The mean olecranon osteotomy site union time was significantly longer in group 2 (7.4 weeks) than in group 2 (4.0 weeks). Olecranon osteotomy site resorption occurred among 6 of 18 patients only in group 2. No significant difference in ROM (flexion, 130°; extension, -0.7°), MEPS (85.7 points), DASH score (20.0 points), or frequency of major complications (TO, 5; AFT, 6) was observed between the groups. Our results showed no advantage of the AFT approach over the TO approach, despite preserving the anconeus. Prospective randomized trials will be necessary to compare the AFT and TO approaches for treating comminuted IDH fractures. [Orthopedics. 2022;45(6):e326-e334.].
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Athanaselis ED, Komnos G, Deligeorgis D, Hantes M, Karachalios T, Malizos KN, Varitimidis S. Double Plating in Type C Distal Humerus Fractures: Current Treatment Options and Factors that Affect the Outcome. Strategies Trauma Limb Reconstr 2022; 17:7-13. [PMID: 35734034 PMCID: PMC9166263 DOI: 10.5005/jp-journals-10080-1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose This is a retrospective cohort study of type C distal humeral fractures (AO classification system) aimed at evaluating the effectiveness of current operative treatment options. Materials and methods Thirty-seven patients with type C distal humeral fractures, treated operatively from January 2002 to September 2016, were retrospectively studied. Thirty-two were eligible for inclusion. Patients were treated by open reduction using the posterior approach, olecranon osteotomy and parallel-plate two-column internal fixation. Patients were evaluated for fracture healing, functional outcomes and complications (infection, ulnar neuropathy, heterotopic ossification and need for implant removal). Restoration of the normal anatomy was defined by measuring carrying angle, posterior angulation and intercondylar distance of distal humerus. Results The mean follow-up time was 8.7 years [range 2–15.5 years, standard deviation (SD) = 3.96]. Mean time to fracture union was 8 weeks for 29 patients (90.6%) (range, 6–10 weeks). In nine cases, there was malunion of varied importance (28.1%). There was one case with postoperative ulnar neuropathy and one case with deep infection. The mean Disabilities of the Arm, Shoulder and Hand (DASH) score and mean Mayo Elbow Performance Score (MEPS) were 20 (range 0–49) and 83.3 (range 25–100), respectively. Conclusion In complex distal humerus fractures, the posterior approach with olecranon osteotomy and parallel plating of two columns, after anatomic reconstruction of the articular segment, is a prerequisite for successful elbow function. How to cite this article Athanaselis ED, Komnos G, Deligeorgis D, et al. Double Plating in Type C Distal Humerus Fractures: Current Treatment Options and Factors that Affect the Outcome. Strategies Trauma Limb Reconstr 2022;17(1):7–13.
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Affiliation(s)
- Efstratios D Athanaselis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Georgios Komnos
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Dimitrios Deligeorgis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Michael Hantes
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Theofilos Karachalios
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Konstantinos N Malizos
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Sokratis Varitimidis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
- Sokratis Varitimidis, Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece, e-mail:
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Risk Factors for Non-Union after Open Reduction and Internal Fixation in Patients with Distal Humerus Fractures. J Clin Med 2022; 11:jcm11102679. [PMID: 35628806 PMCID: PMC9147525 DOI: 10.3390/jcm11102679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Only a few studies have reported on the risk factors for non-union after open reduction and internal fixation (ORIF) in distal humerus fractures. METHODS We retrospectively reviewed 155 patients who underwent ORIF for distal humerus fractures from January 2008 to June 2020. Various patient factors, including body mass index (BMI), diabetes mellitus (DM), and combined fracture, as well as surgical factors, including fixation methods (e.g., orthogonal plate/parallel plate/single plate/tension bend wiring [TBW]) and combined fracture operations, were evaluated as risk factors for non-unions. RESULTS Among the patient factors, BMI (25.0 ± 3.4 vs. 22.7 ± 3.4, p = 0.032), DM (5/13 [38.5%] vs. 20/142 [14.1%], p = 0.038) and combined fracture (5/13 [38.5%] vs. 16/142 [11.3%], p = 0.018) were significantly different between groups with non-union and union. Among the surgical factors, combined fracture operation (5 [38.5%] vs. 9 [6.3%], p = 0.002) and the fixation method (3 [23.1%]/1 [7.7%]/4 [30.8%]/5 [38.5%] vs. 84 [59.2%]/7 [4.9%]/40 [28.2%]/11 [7.7%], p = 0.005) showed a significant difference between groups with non-union and union. Multivariate regression analysis showed that combined fracture operation (OR 10.467; 95% CI 1.880-58.257; p = 0.007) and TBW (OR 9.176; 95% CI 1.474-57.135; p = 0.018) among the fixation methods posed as a significant risk factor for non-union. CONCLUSIONS The risk of non-union increased in patients who underwent surgery for another fracture combined with distal humerus fracture and in patients who underwent ORIF with TBW.
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Somerson JS, Morrey ME, Sanchez-Sotelo J, Morrey BF. Predictors of reoperation after internal fixation of intra-articular distal humerus fractures. Shoulder Elbow 2022; 14:76-83. [PMID: 35154407 PMCID: PMC8832696 DOI: 10.1177/1758573219895972] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/19/2019] [Accepted: 11/27/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite good reported outcomes with open reduction and internal fixation of intra-articular distal humerus fractures, complication rates remain high. The objective of this work is to identify factors associated with reoperation. METHODS Sixty-three patients treated with open reduction and internal fixation for intra-articular (Arbeitsgemeinschaft für Osteosynthesefragen type C) distal humerus fractures between 2004 and 2010 were identified using an institutional trauma registry, 62 of which were followed for a minimum of six months. Age, gender, fracture subclassification, open fracture presence, Injury Severity Score, time to definitive surgery, length of postoperative immobilization, and type of approach were recorded. Multivariate analysis was utilized to identify factors independently associated with reoperation. RESULTS Complications requiring reoperation developed in 25 (40.3%) elbows. The most common reasons were wound dehiscence or infection in nine elbows (14.5%) and symptomatic hardware in six (9.6%). During multivariate analysis, only olecranon osteotomy remained an independent predictor for reoperation (P = 0.043). DISCUSSION Despite improved internal fixation techniques, a high proportion of elbows require reoperation after open reduction and internal fixation for distal humerus fractures. Higher complication rates in fractures fixed through an olecranon osteotomy may reflect additional reoperations due to nonunion of the osteotomy or need to remove hardware from the ulna. LEVEL OF EVIDENCE Prognostic Level III.
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Affiliation(s)
- Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, USA,Jeremy S Somerson, Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, 2.316 Rebecca Sealy, 301 University Blvd Route 0165, Galveston, TX 77555-0165, USA.
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Chen C, Xiao D, Li T, Gong M, Zha Y, Hua K, Sun W, Ji S, Jiang X. 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 Musculoskelet Disord 2021; 22:939. [PMID: 34758812 PMCID: PMC8582176 DOI: 10.1186/s12891-021-04817-1] [Citation(s) in RCA: 1] [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: 08/05/2021] [Accepted: 10/25/2021] [Indexed: 11/14/2022] Open
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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Affiliation(s)
- Chen Chen
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Dan Xiao
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Ting Li
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Maoqi Gong
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Yejun Zha
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Kehan Hua
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Weitong Sun
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Shangwei Ji
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Xieyuan Jiang
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
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Abstract
Approximately 4.1% of all fractures in the elderly involve the elbow. Most elbow injuries in geriatric patients occur as the result of low-energy mechanisms such as falls from standing height. Elbow injuries in elderly patients present complex challenges because of insufficient bone quality, comminution, articular fragmentation, and preexisting conditions, such as arthritis. Medical comorbidities and baseline level of function must be heavily considered in surgical decision making.
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Affiliation(s)
- Naoko Onizuka
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN 55455, USA; Department of Orthopaedic Surgery, Methodist Hospital, 6500 Excelsior Boulevard, Saint Louis Park, MN 55426, USA
| | - Julie Switzer
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN 55455, USA; Department of Orthopaedic Surgery, Methodist Hospital, 6500 Excelsior Boulevard, Saint Louis Park, MN 55426, USA
| | - Chad Myeroff
- TRIA Orthopedic Center, 155 Radio Drive, Woodbury, MN 55125, USA.
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Grogan BF, Danford NC, Lopez CD, Maier SP, Kongmalai P, Kovacevic D, Levine WN, Jobin CM. Number of screws in the articular segment of distal humerus AO/OTA C-type fractures treated with open reduction internal fixation is associated with complication rate. SICOT J 2021; 7:25. [PMID: 33812466 PMCID: PMC8019548 DOI: 10.1051/sicotj/2021006] [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: 05/01/2020] [Accepted: 01/31/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction: Surgical treatment of distal humerus fractures can lead to numerous complications. Data suggest that the number of screws in the distal (articular) segment may be associated with complication rate. The purpose of this study is to evaluate the association between a number of screws in the distal segment and complication rate for surgical treatment of distal humerus fractures. We hypothesize that the number of screws in the articular segment of distal humerus AO/OTA C-type fractures treated with open reduction internal fixation (ORIF) will be inversely proportional to the complication rate. Methods: We performed a single-center retrospective cohort study of 27 patients who underwent ORIF of distal humerus fractures C-type with at least six months of radiographic and clinical follow-up. Clinical outcomes including a range of motion, pain, revision surgery for stiffness and/or heterotopic ossification (HO), nonunion, and persistent ulnar nerve symptoms requiring revision neurolysis were recorded. Results: In C-type fractures, the use of three or fewer articular screws was significantly associated with nonunion or loss of fixation (RR 17, p = 0.006). Nineteen of 36 (53%) patients experienced at least one complication. The surgical approach, plate configuration, age, and ulnar nerve treatment (none, in situ release, transposition) were not associated with the need for revision surgery. Men had a higher risk of requiring surgical contracture release due to improving post-operative stiffness (RR 12, p = 0.02). Conclusion: In this retrospective study, the use of three or fewer screws to fix articular fragments in AO type C fractures was a significant risk for nonunion or loss of fixation. Plate configuration and surgical approach did not correlate with outcomes. Men had higher rates of complications and required more frequent revision surgery compared to women.
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Affiliation(s)
- Brian F Grogan
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, 10032 NY, USA - Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, UW Health at The American Center, 4602 Eastpark Boulevard, Madison, 53718 WI, USA
| | - Nicholas C Danford
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, 10032 NY, USA
| | - Cesar D Lopez
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, 10032 NY, USA
| | - Stephen P Maier
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, 10032 NY, USA
| | - Pinkawas Kongmalai
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, 10032 NY, USA
| | - David Kovacevic
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, 10032 NY, USA
| | - William N Levine
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, 10032 NY, USA
| | - Charles M Jobin
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, 10032 NY, USA
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Lemsanni M, Chafik R, Madhar M, Elhaoury H, Najeb Y. [Sub- and intercondylar fractures of the distal humerus in adults]. Pan Afr Med J 2020; 36:346. [PMID: 33224412 PMCID: PMC7664147 DOI: 10.11604/pamj.2020.36.346.24516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction les fractures articulaires complètes de l’extrémité inférieure de l’humérus de l’adulte sont des lésions rares et graves. Les options thérapeutiques sont nombreuses mais le traitement chirurgical par ostéosynthèse est ardemment défendu. L’objectif de notre travail a été de décrire les caractéristiques épidémiologiques, clinico-radiologiques et thérapeutiques de ces fractures, ainsi que d’évaluer les résultats fonctionnels obtenus chez nos patients. Méthodes nous avons mené une étude prospective sur une période de 3 ans, portant sur 38 patients admis pour fracture articulaire complète sus et inter-condylienne de l’humérus distal (classée type C selon la classification de l’AO), traités chirurgicalement par voie postérieure trans-olécranienne avec un recul moyen de 34 mois. Résultats nous avons remarqué une distribution bimodale avec une atteinte du sujet jeune de sexe masculin d’une part, et une survenue chez les femmes âgées d’autre part. Les étiologies étaient dominées par les accidents de la voie publique chez 78%. Lors du suivi, nous avons noté un seul cas d’infection superficielle du site opératoire et il n’y a eu aucun cas de démontage du matériel ni de pseudarthrose. De surcroit, aucune complication de l’ostéosynthèse de l’olécrane n’a été enregistrée. Les résultats fonctionnels ont été très satisfaisants avec un score de Mayo-Clinic Elbow Performance Score (MEPS) moyen de 86. Conclusion nous considérons que la voie postérieure trans-olécranienne semble être la meilleure voie d’abord de ces fractures puisqu’elle permet une bonne exposition articulaire, condition sine qua non pour une restitution anatomique parfaite et une ostéosynthèse stable afin d’entreprendre une rééducation précoce et adaptée.
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Affiliation(s)
- Meryem Lemsanni
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Ibn Tofail, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Maroc
| | - Rachid Chafik
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Ibn Tofail, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Maroc
| | - Mohamed Madhar
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Ibn Tofail, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Maroc
| | - Hanane Elhaoury
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Ibn Tofail, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Maroc
| | - Youssef Najeb
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Ibn Tofail, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Maroc
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Lauder A, Richard MJ. Management of distal humerus fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:745-762. [DOI: 10.1007/s00590-020-02626-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 01/08/2020] [Indexed: 11/30/2022]
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Jansen H, Eden L, Meffert RH, Heintel T, Frey SP. Posttraumatic elbow agility and reduction of muscle force after intra-articular distal fractures of the humerus in adults. Technol Health Care 2019; 27:431-439. [PMID: 31033473 DOI: 10.3233/thc-191659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Treatment of distal intra-articular humerus fractures is still a technical challenge. Until now, little is known about the regain of strength and elbow agility after surgical treatment of these fractures. Due to small collectives there is only limited data. OBJECTIVE Investigation of regained strength and elbow agility in patients with intra-articular distal humerus fractures. METHODS A total of 28 patients were treated with distal intra-articular humerus fractures followed up for an average period of 62.3 months. The following parameters were examined: Arthrosis, heterotopic ossification, functional outcome (MEPS, DASH score, LES) and isometric strength of the elbow in extension and flexion was tested in 30∘, 60∘ and 90∘ in a custom-made positioning device. RESULTS There was a high complication rate with 32%. At the 60th month post injury, range of motion (ROM) of the elbow was 114∘ with a reduction of 32∘ compared to the contralateral uninjured side (p< 0.001). The highest reduction was seen in extension with an average loss of 16∘ (p< 0.001). Loss of motion correlated with the fracture severity regarding the AO-classification (r= 0.54, p< 0.01). The average regained muscle force was 81.5% in flexion and 92% in extension in comparison to the contralateral healthy side. Patients over 60 years had less range of motion and inferior results in the DASH score compared to younger patients. CONCLUSIONS Functional impairment in terms of reduced ROM and muscle force is a common complication after distal intra-articular humerus fracture. Patients over 60 years have a higher deficit of motion in the injured elbow joint and an inferior clinical outcome. Superiority of modern angle-stable implants could yet not be shown.
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Affiliation(s)
- Hendrik Jansen
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University of Würzburg, Würzburg, Germany
| | - Lars Eden
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University of Würzburg, Würzburg, Germany
| | - Rainer H Meffert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University of Würzburg, Würzburg, Germany
| | - Timo Heintel
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University of Würzburg, Würzburg, Germany
| | - Sönke P Frey
- Department of Orthopedics and Trauma Surgery, St. Josef-Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
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Nestorson J, Rahme H, Adolfsson L. Arthroplasty as primary treatment for distal humeral fractures produces reliable results with regards to revisions and adverse events: a registry-based study. J Shoulder Elbow Surg 2019; 28:e104-e110. [PMID: 30342824 DOI: 10.1016/j.jse.2018.07.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/22/2018] [Accepted: 07/25/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Primary prosthetic replacement has become an accepted method for the treatment of complex distal humeral fractures. The present study investigated implant survival and adverse events related to this procedure based on available Swedish registries and examined the completeness of the Swedish Elbow Arthroplasty register. MATERIALS AND METHODS Patients treated in Sweden with a primary elbow replacement due to a distal humeral fracture between 1999 and 2014 were identified through 3 different registries: The Swedish Elbow Arthroplasty Register, National Board of Health and Welfare inpatient register, and local registries of all orthopedic departments. Prosthetic survival was examined using Cox regression analysis with Kaplan-Meier plots. Adverse events, defined as medical treatment of the affected elbow besides revision, were analyzed separately. The study included 406 elbows in 405 patients, and no register was complete. RESULTS Implant survival at 10 years was 90% (95% confidence interval, 85%-96%), but only 45 patients had an observation time of 10 years or more because 46% of the patients had died, resulting in a mean observation time of 67 (standard deviation, 47) months. An increase in the use of hemiarthroplasties and a proportional decrease of total elbow arthroplasties was detected. There were 18 revisions (4%), and 26 patients (6%) experienced an adverse event, of whom 16 (4%) required surgery. The completeness of the Swedish Elbow Arthroplasty Register regarding primary arthroplasty was 81%. CONCLUSION Primary arthroplasty as treatment of distal humeral fractures produces reliable results with regards to revisions and other adverse events.
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Affiliation(s)
- Jens Nestorson
- Department of Experimental and Clinical Medicine, Linköping University, Linköping, Sweden.
| | - Hans Rahme
- Department of Orthopedics, Elisabeth Hospital, Uppsala, Sweden
| | - Lars Adolfsson
- Department of Experimental and Clinical Medicine, Linköping University, Linköping, Sweden
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13
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Bhayana H, Pandey R, Dhammi IK, Baumann F, Bhatia U. Comparative Study for Assessment of Functional Outcome of Intraarticular AO Type C Distal Humerus Fractures Treated by Parallel Plating. Indian J Orthop 2019; 53:190-195. [PMID: 30906001 PMCID: PMC6394173 DOI: 10.4103/ortho.ijortho_298_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Complex distal end of humerus fractures are one of the most challenging cases in orthopedics. There is a paucity of literature on outcomes of parallel reconstruction plates using olecranon osteotomy technique along with large sample size. This study focuses primarily on rate of various complications encountered in intraarticular AO Type C distal humerus fractures. MATERIALS AND METHODS In this prospective study, we included 94 patients with isolated closed intraarticular AO type C distal and humerus injuries. Exclusion criteria were polytrauma, open injuries, and pathological fractures (except osteoporosis). The followup was done immediate postoperatively, 6 weeks, 6 months, 1 year and at 2 years. Range of motion (ROM), Mayo Elbow Performance Score (MEPS), and Disabilities of the Arm, Shoulder, and Hand (DASH) score was recorded at each visit. Assessment of union was done based on X-ray. Patients were classified into two groups; Group 1 - patients without complications (n = 64) and Group 2 - with one or more complications. RESULTS The average duration of surgery was 2 h and 15 min. The complication rate was 31.9% (30/94), however, a total of 45 complications were noted. The difference between ROM in the two groups was statistically significant (P < 0.05), however, the difference between MEPS and DASH score was not statistically significant. The most common complication found was ulnar nerve neuropathy. CONCLUSION Parallel plating using olecranon osteotomy is an acceptable approach for this fracture, but due to inherent nature of this injury, it has its own set of complications which must be counseled before surgery and active participation of patient is required to obtain realistic expectations and goals for the future.
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Affiliation(s)
- Himanshu Bhayana
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Rohit Pandey
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India,Address for correspondence: Dr. Rohit Pandey, Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, New Delhi - 110 095, India. E-mail:
| | - Ish Kumar Dhammi
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Florian Baumann
- Department of Trauma Surgery, University Hospital Regensburg, Germany
| | - Urveshi Bhatia
- Department of Community Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
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14
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Savvidou OD, Zampeli F, Koutsouradis P, Chloros GD, Kaspiris A, Sourmelis S, Papagelopoulos PJ. Complications of open reduction and internal fixation of distal humerus fractures. EFORT Open Rev 2018; 3:558-567. [PMID: 30662764 PMCID: PMC6335604 DOI: 10.1302/2058-5241.3.180009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Treatment of distal humerus fractures is demanding. Surgery is the optimal treatment and preoperative planning is based on fracture type and degree of comminution. Fixation with two precontoured anatomical locking plates at 90o:90o orthogonal or 180o parallel is the optimal treatment. The main goal of surgical treatment is to obtain stable fixation to allow immediate postoperative elbow mobilization and prevent joint stiffness. Despite evolution of plates and surgical techniques, complications such as mechanical failure, ulnar neuropathy, stiffness, heterotopic ossification, nonunion, malunion, infection, and complications from olecranon osteotomy are quite common. Distal humerus fractures still present a significant technical challenge and need meticulous technique and experience to achieve optimal results.
Cite this article: EFORT Open Rev 2018;3:558-567. DOI: 10.1302/2058-5241.3.180009
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Affiliation(s)
- Olga D Savvidou
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Frantzeska Zampeli
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | | | - George D Chloros
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Aggelos Kaspiris
- Department of Trauma and Orthopaedics, Thriasio General Hospital-NHS, Athens, Greece
| | - Savas Sourmelis
- First Department of Orthopaedics, Hygeia Hospital, Athens, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
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Ul Islam S, Glover AW, Waseem M. Challenges and Solutions in Management of Distal Humerus Fractures. Open Orthop J 2017; 11:1292-1307. [PMID: 29290867 PMCID: PMC5721336 DOI: 10.2174/1874325001711011292] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 10/02/2017] [Accepted: 10/05/2017] [Indexed: 11/22/2022] Open
Abstract
Background Management of distal humerus fractures remains a challenge for trauma surgeons and advancements in treatment options continue to be made to achieve the best results for patients presenting with these complex fractures. Our aim in this article is to provide the surgeons with a detailed review of current literature to help them make an evidence based decision when faced with managing such complex injuries in their surgical practice. Methods This is a comprehensive review of the current literature that details various aspects of distal distal humerus fractures such as classification, surgical anatomy, surgical approaches, treatment options, choices of devices, outcomes and complications. Results With the advancements in techniques and equipment, there has been improvement in patients' outcomes following surgical management of these fractures and a large proportion of these patients are able to achieve pre-injury level of function. The contoured locking plates have enabled successful fixation of many of these fractures that were previously considered unfixable. For those not amenable to surgical fixation, total elbow arthroplasty and elbow hemiarthroplasty are considered as good alternatives. Conclusion Since the days where the 'bag of bones' technique was the preferred method of treating these complex injuries, techniques and outcomes have advanced greatly. However, they still present a significant technical challenge and need meticulous technique and experience to achieve optimal results.
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Affiliation(s)
- Saif Ul Islam
- Macclesfield District General Hospital, Cheshire, United Kingdom
| | | | - Mohammad Waseem
- Macclesfield District General Hospital, Cheshire, United Kingdom
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16
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The influence of body mass index on outcome of open arthrolysis for post-traumatic elbow stiffness. J Shoulder Elbow Surg 2017; 26:809-814. [PMID: 28162879 DOI: 10.1016/j.jse.2016.12.065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/11/2016] [Accepted: 12/26/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Being overweight has become a serious public health concern in China. Higher body mass index has been proven to be associated with poor outcome after orthopedic surgery. The purpose of this study was to examine the effect of being overweight on functional outcomes and complications after open arthrolysis for post-traumatic elbow stiffness. METHODS We performed a retrospective study including 122 patients with post-traumatic elbow stiffness undergoing arthrolysis, including 84 in the normal weight group and 38 in the overweight group. Demographic data, surgical data, and data on preoperative and postoperative functional performance and complications were obtained. RESULTS Demographic data and disease characteristics were comparable between the 2 groups at baseline. All patients showed significant improvement after elbow arthrolysis. Postoperatively, the range of motion and Mayo Elbow Performance Score of the normal weight group were significantly better than those of the overweight group. Sixteen patients developed postoperative complications. No significant differences in complication rates between the 2 groups were found. CONCLUSIONS Most patients showed satisfactory functional outcomes after arthrolysis. The postoperative functional outcomes of the overweight group were inferior to those of the normal weight group to a certain extent. This study underlines the importance of detailed rehabilitation instructions in patients with higher body mass index.
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17
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Chou YC, Hsu YH, Yu YH, Wu CC. Triceps-reflecting anconeus pedicle approach with double precontoured locking plate fixation is efficient in the treatment of orthopaedic trauma association type C distal humerus fracture. Injury 2016; 47:2240-2246. [PMID: 27424532 DOI: 10.1016/j.injury.2016.06.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 06/15/2016] [Accepted: 06/27/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to determine if the triceps-reflecting anconeus pedicle (TRAP) approach combined with the precontoured locking plate can provide acceptable clinical outcomes in the treatment of comminuted distal humerus fracture. METHODS Between August 2008 and June 2014, 48 patients with Orthopaedic Trauma Association type C (21 with C2, 27 with C3) distal humerus fractures underwent open reduction and internal fixation with orthogonal precontoured locking plate fixation using the TRAP approach. Occurrences of bony union, implant failure, posttraumatic arthrosis, and heterotopic ossification were detected with radiography. Clinical assessment included evaluation of range of motion and determination of the pain score, Mayo Elbow Performance Index (MEPI) score, and Disability of the Arm Shoulder and Hand (DASH) score. RESULTS The fractures healed within 3 months in 25 patients (53%) and within 6 months in 23 patients (47%). The 12-month assessment revealed improved elbow movement, with the mean arc of flexion-extension of 121° (range, 100°-140°), mean arc of supination-pronation of 163° (range, 150°-180°), and mean flexion contracture of 8° (range, 0°-30°). The mean MEPI score was 81 and the mean DASH score was 11.7. CONCLUSIONS By retaining the intact olecranon by the TRAP approach, orthopedic surgeon can get adequate surgical exposure for fracture fixation and can use olecranon as a three-dimensional template to restore the articular fragments. The promising results in this study obtain because that precise identification of the triceps muscle allowed the determination of a proper length-tension relationship for triceps reattachment. The combination of triceps tendon repair and anconeous muscle repair ensured the strength of the extensor mechanism. Therefore, the TRAP approach in combination with the usage of the precontoured locking plate can be recommended as the optimal surgical approach for the treatment of comminuted distal humerus fracture.
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Affiliation(s)
- Ying-Chao Chou
- Department of Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Yung-Heng Hsu
- Department of Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Yi-Hsun Yu
- Department of Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Chi-Chuan Wu
- Department of Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
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18
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Tan CJ, Johnson KA. Stabilisation of periarticular fractures and osteotomies with a notched head locking T-plate. Aust Vet J 2016; 94:377-83. [PMID: 27671082 DOI: 10.1111/avj.12487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 01/27/2016] [Accepted: 02/16/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report the clinical outcomes and complications of small animals that had articular or periarticular fractures or osteotomies stabilised with a notched head locking T-plate. METHODS Medical records were searched retrospectively to identify animals that had a notched head locking T-plate used to stabilise a small articular or periarticular bone fragment. RESULTS Nine dogs and two cats had an articular or periarticular bone fragment stabilised with a 2.0- or 2.4-mm notched head locking T-plate (12 procedures). The median body weight was 4.7 kg. The plate was modified by removing holes in 10/12 procedures and a combination of locking and non-locking screws were used in 7/12 procedures. All fractures or osteotomies progressed to clinical union. There were two intraoperative complications (intra-articular screw placement and overlong screw) and two postoperative complications (skin necrosis and stress protection) CONCLUSIONS This study reports the successful use of a 2.0- or 2.4-mm notched head locking T-plate for articular or periarticular fractures or osteotomies in a variety of small-breed dogs and cats. Care must be taken to prevent inadvertent penetration of the articular surface, particularly in regions such as the proximal tibia. The ability to modify the plate dimensions intraoperatively proved beneficial in most cases.
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Affiliation(s)
- C J Tan
- Faculty of Veterinary Science, University of Sydney, New South Wales 2006, Australia.
| | - K A Johnson
- Faculty of Veterinary Science, University of Sydney, New South Wales 2006, Australia
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19
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Phadnis J, Watts AC, Bain GI. Elbow hemiarthroplasty for the management of distal humeral fractures: current technique, indications and results. Shoulder Elbow 2016; 8:171-83. [PMID: 27583016 PMCID: PMC4950283 DOI: 10.1177/1758573216640210] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/25/2016] [Indexed: 11/16/2022]
Abstract
There has been a growing recent interest in the use of elbow hemiarthroplasty for the treatment of distal humeral trauma in select patients. However, the current available evidence regarding outcome after elbow hemiarthroplasty is limited to case series and biomechanical data. Consequently, the procedure remains unfamiliar to many surgeons. The aim of the present review is to outline the evidence regarding elbow hemiarthroplasty and to use this, along with the author's experience, to better describe the indications, surgical technique and outcomes after this procedure.
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Affiliation(s)
- Joideep Phadnis
- Department of Orthopaedics, Brighton and Sussex University Hospitals, Brighton, UK,Joideep Phadnis, 70 Nevill Avenue, Hove, East Sussex BN3 7NA, UK. Tel: +44 (0)7496853014.
| | - Adam C Watts
- Upper Limb Unit, Wrightington Hospital, Wigan, UK
| | - Gregory I Bain
- Department of Orthopaedics, Flinders University, Bedford Park, SA, South Australia
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20
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Plate and Screw Fixation of Bicolumnar Distal Humerus Fractures: Factors Associated With Loosening or Breakage of Implants or Nonunion. J Hand Surg Am 2015; 40:2045-2051.e2. [PMID: 26319772 DOI: 10.1016/j.jhsa.2015.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 07/06/2015] [Accepted: 07/06/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify factors associated with reoperation for early loosening or breakage of implants or nonunion after operative treatment of AO type C distal humerus fractures. METHODS We retrospectively analyzed 129 adult patients who had operative treatment of an isolated AO type C distal humerus fracture at 1 of 5 hospitals to determine factors associated with reoperation for early loosening or breakage of implants or nonunion. RESULTS Within 6 months of original fixation, 16 of 129 fractures (12%) required reoperation for loosening or breakage of implants (n = 8) or nonunion (n = 8). In bivariate analyses, the Charlson comorbidity index, smoking, a coded diagnosis of obesity, diabetes mellitus, and radiographic osteoarthritis were significantly associated with reoperation for early loosening or breakage of implants or nonunion. CONCLUSIONS With the numbers available, patient factors rather than technical factors were associated with reoperation for loosening or breakage of implants and nonunion. Because of the relative infrequency of fixation problems and nonunion, a much larger study is needed to address technical deficiencies.
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21
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Desloges W, Faber KJ, King GJW, Athwal GS. Functional outcomes of distal humeral fractures managed nonoperatively in medically unwell and lower-demand elderly patients. J Shoulder Elbow Surg 2015; 24:1187-96. [PMID: 26189804 DOI: 10.1016/j.jse.2015.05.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 05/03/2015] [Accepted: 05/04/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is scant contemporary literature describing the outcomes of nonoperative management of distal humeral fractures. The aim of this study was to report the functional and radiographic outcomes after nonoperative management of distal humeral fractures. METHODS Between 2007 and 2013, 32 low-demand, medically unwell, or older patients with distal humeral fractures were treated nonoperatively. At the time of this study, 8 patients had died of unrelated causes, and 5 patients were lost to follow-up. The remaining 19 patients, with a mean age of 77 years, were available for a comprehensive assessment. RESULTS At a mean of 27 ± 14 months of follow-up, 68% (13 of 19) of patients reported good to excellent subjective outcomes. Outcomes in 2 patients were classified as poor, one of whom underwent total elbow arthroplasty as a result. Overall, the mean score on the Patient Rated Elbow Evaluation was 16 ± 23 and the Mayo Elbow Performance Index was 90 ± 11. When the injured was compared with the uninjured side, extension (22° ± 11° vs 8° ± 12°; P = .025) and flexion (128° ± 16° vs 142° ± 7°; P = .002) were significantly worse in the injured elbows. The fracture union rate was 81% (22 of 27) at a mean radiographic follow-up of 12 months. CONCLUSIONS Satisfactory outcomes were observed after the nonoperative management of selected distal humeral fractures in lower-demand, medically unwell, or older patients. Fracture union can be expected in most patients. In the uncommon instance when an unsatisfactory outcome occurs, successful salvage can be achieved with conversion to a total elbow arthroplasty.
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Affiliation(s)
- William Desloges
- Division of Orthopedic Surgery, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Centre, University of Western Ontario, London, ON, Canada
| | - Kenneth J Faber
- Division of Orthopedic Surgery, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Centre, University of Western Ontario, London, ON, Canada
| | - Graham J W King
- Division of Orthopedic Surgery, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Centre, University of Western Ontario, London, ON, Canada
| | - George S Athwal
- Division of Orthopedic Surgery, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Centre, University of Western Ontario, London, ON, Canada.
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Dickens JF, Wilson KW, Tintle SM, Heckert R, Gordon WT, D'Alleyrand JCG, Potter BK. Risk factors for decreased range of motion and poor outcomes in open periarticular elbow fractures. Injury 2015; 46:676-81. [PMID: 25681150 DOI: 10.1016/j.injury.2015.01.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 01/04/2015] [Accepted: 01/10/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of this study was to identify risk factors present at the time of injury that predict poor functional outcomes and heterotopic ossification (HO) in open periarticular elbow fractures. MATERIALS AND METHODS We performed a retrospective review of 136 combat-related open elbow fractures from 2003 to 2010. Patient demographics, injury characteristics, treatment variables, and complications were recorded. Functional outcomes were analyzed to determine range of motion (ROM) and Mayo Elbow Performance Score (MEPS). Secondary outcome measures included the development of HO, return to duty, and revision operation. RESULTS At a median 2.7 years from injury the median MEPS was 67.8 (range 30-100) with an average ulnohumeral arc motion of 89°. Bipolar fractures, with periarticular fractures on both sides of the elbow and at least one side containing intra-articular extension, were independently associated with decreased ulnohumeral motion (p=0.02) and decreased MEPS (p<0.004). Additional independent risk factors for decreased ROM included more severe osseous comminution (p=0.001), and increased time to definitive fixation (p=0.03) and HO (p=0.02). More severe soft tissue injury (Gustilo and Anderson fracture type, p=0.02), peripheral nerve injury (p=0.04), and HO (p=0.03) were independently associated with decreased MEPS. HO developed in 65% (89/136) of extremities and was associated with more severe Orthopaedic Trauma Association (OTA) fracture type (p=0.01) and escalating Gustilo and Anderson fracture classification (p=0.049). CONCLUSIONS In the largest series of open elbow fractures, we identified risk factors that portend a poor clinical outcome and decreased ROM. Bipolar elbow fractures, which have not previously been associated with worse results, are particularly prone to decreased ROM and worse outcomes. LEVEL OF EVIDENCE Prognostic level IV.
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Affiliation(s)
- Jonathan F Dickens
- Department of Orthopaedics, Walter Reed National Military Medical Center, America Building (Bldg 19), 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
| | - Kevin W Wilson
- Department of Orthopaedics, Walter Reed National Military Medical Center, America Building (Bldg 19), 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Scott M Tintle
- Department of Orthopaedics, Walter Reed National Military Medical Center, America Building (Bldg 19), 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Reed Heckert
- Department of Orthopaedics, Walter Reed National Military Medical Center, America Building (Bldg 19), 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Wade T Gordon
- Department of Orthopaedics, Walter Reed National Military Medical Center, America Building (Bldg 19), 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Jean-Claude G D'Alleyrand
- Department of Orthopaedics, Walter Reed National Military Medical Center, America Building (Bldg 19), 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Benjamin K Potter
- Department of Orthopaedics, Walter Reed National Military Medical Center, America Building (Bldg 19), 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
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Kumar S, Singh S, Kumar D, Kumar N, Verma R. Intercondylar humerus fracture- parallel plating and its results. J Clin Diagn Res 2015; 9:RC01-4. [PMID: 25738046 DOI: 10.7860/jcdr/2014/12137.5479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 12/15/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intercondylar fracture of humerus is one of the commonest fractures of young adult and counts for about 30% of all elbow fractures. The treatment of these fractures continues to present challenges despite advances in internal fixation. Although orthogonal plating use to provid adequate functional results in these fractures, parallel plating is said to be mechanically more stable construct thus allowing early mobilization and better range of motion. AIM AIM of the study is to assess the clinical as well functional results of these fractures treated with parallel plating. STUDY AND DESIGN Prospective study in a tertiary care hospital. MATERIALS AND METHODS A total of 23 fresh patients of intercondylar fracture of humerus from Jan 2013 to May 2014 were included in the study and were treated with parallel plating. These patients were followed at 3, 6, 12, 24 weeks and at 1year of follow up and assessed in terms of time for union, range of motion, MAYO score, DASH score and complication rate. RESULTS At final follow up Mayo score was 96.32±04.96 from 5.00±01.26 and DASH SCORE was 31.42±2.04 which dropped from 150±05.34, Range of motion improved from 21.38±05.70 to 116.1±07.92 with 100% union rate and complications less than 19%. CONCLUSION Parallel plating for intercondylar fracture of humerus is excellent method of fixation and results are similar to those treated with orthogonal plating.
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Affiliation(s)
- Sanjiv Kumar
- Assistant Professor, Department of Orthopaedics, Era's Lucknow Medical College & Hospital , Lucknow, India
| | - Sudhir Singh
- Professor & Head, Department of Orthopaedics, Era's Lucknow Medical College & Hospita , Lucknow, India
| | - Dharmender Kumar
- Assistant Professor, Department of Orthopaedics, Era's Lucknow Medical College & Hospita , Lucknow, India
| | - Neeraj Kumar
- Junior Resident Department of Orthopaedics, Era's Lucknow Medical College & Hospita , Lucknow, India
| | - Reetu Verma
- Assistant Professor, Department of Anaesthesiology, KGMU , Lucknow, India
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24
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Simone JP, Streubel PN, Sanchez-Sotelo J, Morrey BF. Low transcondylar fractures of the distal humerus: results of open reduction and internal fixation. J Shoulder Elbow Surg 2014; 23:573-8. [PMID: 24630549 DOI: 10.1016/j.jse.2013.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/25/2013] [Accepted: 12/03/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study presents the outcomes of low transcondylar fractures of the distal humerus treated by open reduction and internal fixation. METHODS Between 1996 and 2010, 263 distal humeral fractures were managed at our institution. Patients with a true low transcondylar fracture treated by open reduction and internal fixation were included. Fourteen patients form the basis of this study. Fracture fixation was achieved through a triceps-sparing approach, a triceps tongue, or an olecranon osteotomy. Internal fixation was performed with parallel plates, orthogonal plates, a single lateral plate, or a single medial plate. The clinical outcome was measured with pain levels, range of motion, and the Mayo Elbow Performance Score. Radiographs at latest follow-up were assessed for union, delayed union, nonunion, and hardware failure. RESULTS At most recent follow-up, 11 patients had no pain, 2 had mild pain, and 1 had moderate pain. The mean Mayo Elbow Performance Score was 85. The mean arch of motion was 95°. Complications included nonunion, delayed union, wound complications, deep infection, and heterotopic ossification. DISCUSSION Stable internal fixation of low transcondylar fractures is perceived as difficult to achieve because of the very small size of the distal fragment. However, the results of our study indicate that internal fixation of low transcondylar fractures of the distal humerus is associated with a high union rate and satisfactory clinical results. Elbow arthroplasty does not need to be considered for most patients with a low transcondylar distal humeral fracture.
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Affiliation(s)
- Juan P Simone
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Bernard F Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Outcomes of distal humerus diaphyseal injuries fixed with a single-column anatomic plate. INTERNATIONAL ORTHOPAEDICS 2013; 38:1037-43. [PMID: 24337886 DOI: 10.1007/s00264-013-2213-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 11/15/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE The locking compression extra-articular distal humerus plate (EADHP) is an anatomically shaped, angular stable single-column fixation system for distal third humerus fractures. The purpose of this retrospective study was to evaluate clinical and radiographic outcomes after open reduction and internal fixation of distal humerus fractures with this device. METHODS Twenty-one consecutive patients with distal humerus fractures were treated with the EADHP system between February 2006 and June 2012. Of these, 19 were clinically and radiographically evaluated after a mean follow-up of 10.4 months. Follow-up assessment included anteroposterior and lateral radiographs, assessment of range of motion (ROM), pain according to a visual analogue scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS All fractures demonstrated satisfactory reduction and healing at an average of 7.3 months. One patient showed post-operative sensory ulnar neuropathy that recovered completely, and nine patients had a preoperative radial nerve palsy, which recovered spontaneously following exploration and plating. Mean post-operative ROM was as follows: flexion 126°, extension -7°, pronation 82° and supination 83°. The VAS score was zero points in eight patients, while the mean DASH score was 25.8 points. CONCLUSIONS For extra-articular distal humerus fractures, including high-energy injuries often seen in gunshot wounds or motor vehicle injuries, the anatomically shaped angular stable single-column plate provides satisfactory clinical and radiographic results and serves as a valuable tool in the treatment of these injuries.
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Saragaglia D, Rouchy RC, Mercier N. Fractures of the distal humerus operated on using the Lambda® plate: report of 75 cases at 9.5 years follow-up. Orthop Traumatol Surg Res 2013; 99:707-12. [PMID: 24029585 DOI: 10.1016/j.otsr.2013.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 04/14/2013] [Accepted: 04/30/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The study sought to assess the functional results and complications of osteosynthesis using the Lambda(®) plate (Zimmer, Étupes, France) in treating fracture of the distal extremity of the humerus. MATERIALS AND METHODS The initial series comprised 115 patients (116 fractures), treated between 1992 and 2008. Forty-one (mainly foreigners) were lost to follow-up. The final series thus comprised 74 patients (75 fractures): 44 female and 30 male, with a mean age of 46±23 years (range, 16-95 years), 22 (29%) being aged 65 years or over. According to AO classification, 22 of the fractures of the distal extremity of the humerus (29%) were diaphyseal-metaphyseal, corresponding to a particular grade of type A2, 12 (16%) were type A2 or A3, six (8%) type B, and 35 (47%) type C. Eight were open fractures: seven grade 1 and one grade IIa on Gustilo's classification. The Lambda(®) plate is an inverted Y shape, with a stem of up to ten holes and sectile arms that can be remodeled to adapt perfectly to the type of fracture and the shape of the distal end of the humerus. A posterior approach was used in all cases: in 26 cases, an extra-articular transolecranal approach and otherwise a transtricipital approach, either vertical for diaphyseal-metaphyseal fracture or inverted V for type-C fracture. RESULTS Mean follow-up was 115±64 months (range, 24-227 months). There were no cases of infection, non-union of olecranial osteotomy or disassembly of the internal fixation; there was, on the other hand, one case of non-union of the lateral condyle and one of the distal extremity of the humerus, two cases of dysesthesia in the ulnar nerve territory and one in the radial nerve territory (following preoperative paralysis), and four cases of stiffness requiring surgical arthrolysis between 6 and 12 months postoperatively. At follow-up, mean active elbow flexion was 133°±13° (range, 90°-150°) and active extension -12°±14° (range, -45°-0°). Mean elbow flexion range of motion exceeded 100° in 58 patients (77%), was between 50° and 100° in 16 (21%) and was less than 50° in one. Mean Mayo Elbow Performance Score (MEPS) was 97±7 points (range, 40-100), and mean Quick DASH Score (converted as a score out of 100) was 10±18 (range, 0-54). There were 67 excellent results (MEPS, 90-100 points), five good (75-89), two moderate and one poor. The 35 type-C fractures displayed no significant differences from the series as a whole (P=1.24 for MEPS). CONCLUSION Osteosynthesis using the Lambda(®) plate gave excellent medium-term results in terms of both fixation stability and recovery of elbow function after fracture of the distal extremity of the humerus, even in elderly osteoporotic patients. LEVEL OF EVIDENCE Level IV: retrospective study.
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Affiliation(s)
- D Saragaglia
- Department of Orthopedic Surgery and Sports Traumatology, CHU de Grenoble, hôpital Sud, 38130 Échirolles, France.
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Schmidt-Horlohé KH, Bonk A, Wilde P, Becker L, Hoffmann R. Promising results after the treatment of simple and complex distal humerus type C fractures by angular-stable double-plate osteosynthesis. Orthop Traumatol Surg Res 2013; 99:531-41. [PMID: 23755958 DOI: 10.1016/j.otsr.2013.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 01/22/2013] [Accepted: 02/18/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the functional results and complications following open reduction and internal fixation of distal humerus type C fractures (AO classification) using an anatomically precontoured, angular-stable double-plate system. PATIENTS AND METHODS The study is a retrospective analysis of 45 patients with 46 type C fractures. There was one C1, eight C2 and 31 C3 fractures. Twelve fractures were open (Gustilo classification). Follow-up was performed on 38 patients with 39 fractures (84%) after 14 months (range, 12-22). The mean age was 50 years (range, 14-87). Functional results were evaluated using the Mayo Elbow Performance Score (MEPS); the Disabilities of the Arm, Shoulder and Hand score (DASH); and range-of motion (ROM) measurements. Complications were classified as minor or major, and the postoperative and follow-up X-rays were analyzed. RESULTS Thirty-four fractures were considered stable to allow early physical therapy. With a mean MEPS of 85 points, 36 results (36/39 [92%]) were rated as excellent or good. The mean DASH was 22.5 points, and the ROM for extension-flexion was 105° (range, 50-145). Sixteen major complications (eventually coexistent: 6 × implant failure, 3 × non-union, 6 × stiffness, 2 × necrosis capitulum, 4 × failure olecranon osteotomy refixation) and two minor complications were recorded in 17 patients. These adverse events led to 14 revision surgeries (14/39 [36%]). Except for extension deficit, no statistically significant differences were found between the articular simple and articular complex fractures and when comparing the results between patients with and without a major complication. CONCLUSION The anatomically precontoured and angular-stable double-plate system provides sufficient immediate postoperative stability to allow early physiotherapy, even in C3-type fractures. Excellent or good results could be achieved in the vast majority of patients, independent on having suffered a complication or not. Complication rates were remarkably high, emphasizing the difficulties associated with this rare type of fracture. LEVEL OF EVIDENCE Level IV Retrospective study.
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Affiliation(s)
- K H Schmidt-Horlohé
- Department for Trauma Surgery and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt, Friedberger Landstrasse 430, 60389 Frankfurt, Germany.
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Dietz SO, Burkhart KE, Nowak TE, Rommens PM, Müller LP. Distal humerus fractures in the elderly: osteosynthesis or endoprosthesis? Review of the literature. Eur J Trauma Emerg Surg 2012; 38:605-15. [PMID: 26814545 DOI: 10.1007/s00068-012-0216-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
Abstract
Fractures of the distal humerus in adults are rare but challenging for the orthopaedic trauma surgeon. The bimodal distribution reflects the trauma mechanism. While distal humerus fractures are caused by high-energy traumata in young male adults, a fall from a standing height is the most common reason for humerus fractures among elderly females. As a rule, fractures of the distal humerus are treated surgically. In young patients, open reduction and internal fixation (ORIF) with anatomic locking plates are the gold standard. In elderly patients, reconstruction is not always possible, and total elbow arthroplasty (TEA) becomes necessary. The present article provides an overview of the current diagnostic and treatment recommendations. The current literature is reviewed and the results discussed.
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Affiliation(s)
- S O Dietz
- Center of Musculoskeletal Surgery, University Medical Center, Johannes Gutenberg-University, Mainz, Germany.
| | - K E Burkhart
- Department of Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
| | - T E Nowak
- Center of Musculoskeletal Surgery, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - P M Rommens
- Center of Musculoskeletal Surgery, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - L P Müller
- Department of Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
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Vennettilli M, Athwal GS. Parallel versus orthogonal plating for distal humerus fractures. J Hand Surg Am 2012; 37:819-20. [PMID: 22119605 DOI: 10.1016/j.jhsa.2011.10.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 10/16/2011] [Indexed: 02/02/2023]
Affiliation(s)
- Marco Vennettilli
- Hand and Upper Limb Centre, St Joseph's Health Care, University of Western Ontario, Ontario, Canada
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Erpelding JM, Mailander A, High R, Mormino MA, Fehringer EV. Outcomes following distal humeral fracture fixation with an extensor mechanism-on approach. J Bone Joint Surg Am 2012; 94:548-53. [PMID: 22438004 DOI: 10.2106/jbjs.j.01785] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distal humeral fractures have traditionally been managed with surgical approaches that disrupt the extensor mechanism. We hypothesized that an extensor mechanism-on approach for operative fixation of distal humeral fractures with parallel or orthogonal plate constructs would allow excellent healing, a motion arc of the elbow exceeding 100°, and maintenance of extensor mechanism strength. METHODS Distal humeral open reduction and internal fixation (ORIF) was performed with either orthogonal or parallel plate constructs in seventy-nine elbows. Thirty-seven elbows were fixed via an extensor mechanism-on surgical approach, and twenty-four of them were available for additional evaluation. Radiographs as well as MEPI (Mayo Elbow Performance Index), DASH (Disabilities of the Arm, Shoulder and Hand), and SF-36 (Short Form-36) scores were obtained. RESULTS All thirty-seven fractures healed primarily. Three elbows underwent later release because of stiffness. The median arc of elbow motion was 126° (range, 60° to 141°). The mean MEPI was 91.5 points and the mean DASH score was 15.9 points, indicating excellent scores with mild impairment. The median percent loss of triceps strength was 10% (range, 0% to 49%) compared with the contralateral, normal elbow. CONCLUSIONS Open treatment of distal humeral fractures with an extensor mechanism-on approach results in excellent healing, a mean elbow flexion-extension arc exceeding 100°, and maintenance of 90% of elbow extension strength compared with that of the contralateral, normal elbow.
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Affiliation(s)
- Jason M Erpelding
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, 981080 Nebraska Medical Center, Omaha, NE 68198, USA.
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Abstract
Distal humeral fractures in adults are relatively uncommon injuries that require operative intervention in the majority of cases. Dual plate fixation, with placement of a separate strong plate on each column and orientation of the plates either at 90° or 180° to each other, is indicated for all adult fractures involving both columns of the distal part of the humerus. Acute total elbow arthroplasty is the preferred treatment for elderly patients with a displaced, comminuted, intra-articular distal humeral fracture that is not amenable to stable internal fixation. Displaced coronal shear fractures of the distal humeral articular surface require operative fixation, most typically via a lateral approach.
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Affiliation(s)
- Aaron Nauth
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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Bell JE. Advances in elbow fracture management. CURRENT ORTHOPAEDIC PRACTICE 2010. [DOI: 10.1097/bco.0b013e3181e9a5a5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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