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Lari A, Alrumaidhi Y, Martinez D, Ahmad A, Aljuwaied H, Alherz M, Prada C. Clinical Outcomes and Management Strategies for Capitellum and Trochlea Fractures: A Systematic Review. Orthop Res Rev 2024; 16:179-197. [PMID: 38947420 PMCID: PMC11214803 DOI: 10.2147/orr.s472482] [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] [Received: 04/06/2024] [Accepted: 06/20/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose Capitellum and trochlea fractures, also referred to as coronal shear fractures of the distal humerus, are infrequent yet challenging intra-articular fractures of the elbow. There are a variety of surgical approaches and fixation methods with often variable outcomes. This systematic review investigates interventions, outcomes and complications of capitellum and trochlea fractures. Methods A systematic review of studies published in MEDLINE, EMBASE, Web of Science and Cumulative Index to Nursing and Allied Health literature (CINAHL) was conducted to assess the clinical outcomes of capitellum and trochlea fractures managed surgically. Data on patient demographics, surgical approach, implant usage, postoperative outcomes and complications were compiled. Results Forty-one studies met the inclusion criteria with a total of 700 patients. Surgical interventions primarily utilized either the lateral (79%) or antero-lateral (15%) approaches with headless compression screws as the most common fixation method (68%). Clinical outcomes were measured using the Mayo Elbow Performance Index (MEPI) with a mean score of 89.9 (±2.6) and the DASH score with a mean of 16.9 (±7.3). Elbow range of motion showed a mean flexion of 126.3° (±19.4), extension of 5.71° (±11.8), pronation of 75.23° (±12.2), and supination of 76.6° (±9.8). The mean flexion-extension arc was 113.7° (±16.9), and the mean pronation-supination arc was 165.31° (±9.41). Complications occurred in 19.8% of cases, with re-interventions required in 8.3% of cases, mainly due to symptomatic implants and elbow stiffness requiring surgical release. Other complications included implant removal (10.4%), overall reported stiff elbows (6%), nerve palsies (2%), non-union (1.5%), and infection (1.2%). Conclusion The treatment of capitellum and trochlea fractures yields satisfactory outcomes but has a considerable rate of complications and reoperations primarily due to symptomatic implants and elbow stiffness. There is noteworthy variability in the achieved range of motion, suggesting unpredictable outcomes. Deficits in functionality and range of motion are common after surgery, especially with more complex injury patterns.
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Affiliation(s)
- Ali Lari
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Yasmen Alrumaidhi
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Diego Martinez
- Hospital of the Worker of Santiago: Hospital del Trabajador de Santiago, Santiago, Chile
| | - Amaar Ahmad
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Hamad Aljuwaied
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Mohammad Alherz
- Department of Anatomy, Trinity College Dublin, Dublin, Ireland
| | - Carlos Prada
- St Joseph’s Health Care, Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada
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Coronal Plane Articular Shear Fractures of the Distal Humerus. J Am Acad Orthop Surg 2023; 31:e235-e245. [PMID: 36727959 DOI: 10.5435/jaaos-d-21-00291] [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] [Received: 03/10/2021] [Accepted: 12/13/2022] [Indexed: 02/03/2023] Open
Abstract
Coronal plane articular shear fractures of the distal humerus are a rare injury, comprising 6% of distal humerus fractures. The fracture can be easily missed on initial radiographs; therefore, a high index of suspicion is warranted. Radiographically obvious fractures are often more complex than initially appreciated, with plain radiographs often underestimating the extent of posterior comminution and trochlear involvement. Associated bony and ligamentous injuries are common. Anatomic reduction and internal fixation of displaced fractures is the standard of care because poor results have been described with nonsurgical treatment. However, the regional anatomy and the often-limited bone stock can make open reduction and internal fixation challenging. The lateral approach, with headless compression screws placed from anterior to posterior, is commonly used for simpler fracture patterns, but exposure and fixation of trochlea extension can be difficult. In the absence of posterior comminution, the anterolateral approach can enhance trochlea exposure and allow for a better trajectory for screw placement. Posterior comminution often requires locking plate fixation. Better results and lower complication rates have been reported for fractures with less fragmentation of the articular surface and those without posterior comminution. Contracture and symptomatic implants are the most common reasons for revision surgery.
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Vicenti G, Bizzoca D, Zaccari D, Buono C, Carlet A, Solarino G, Giorgino R, Santolini E, Lunini E, Zavattini G, Ottaviani G, Carrozzo M, Simone F, Marinelli A, Rotini R, Franchini A, Moretti B. Choice of treatments of the coronal shear fractures of the humerus. A national survey of Italian AO members. Injury 2022; 54 Suppl 1:S78-S84. [PMID: 36400627 DOI: 10.1016/j.injury.2022.11.015] [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: 02/20/2022] [Revised: 10/10/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Coronal shear fractures of the distal humerus are uncommon injuries representing 6% of distal humeral fractures. There is no univocal consensus about the correct management of this type of fracture. A national survey was conducted to gain more insight into the current classification, diagnosis and treatment of coronal shear fractures in Italy. MATERIALS AND METHODS A postal survey was sent to all AO Italian members including residency orthopaedic surgeons. The survey consisted of general questions about personal experience in the management of these fractures: types of classification systems used, surgical approaches, treatment options and rehabilitation programs. RESULTS 114 orthopaedic surgeons answered a 13-items questionnaire. The most used classification system was AO/OTA (72,8%). Independent screws and if necessary plates were the most answered regarding surgical treatment (81,6%). The most encountered post-surgical complication was stiffening of the elbow (81,6%). CONCLUSION An algorithm of treatment has been proposed. To better classify coronal shear fractures, the authors recommended the integration of two classification systems: AO and Dubberley classifications. In the case of posterior wall comminution, a Kocher extensile approach is recommended, otherwise, if a posterior wall is intact, Kocher or Kaplan approach can be used. The posterior transolecranic approach can be reserved to Dubberley type III or AO 13B3.3. The best treatment choice is represented by independent screws and plates placed according to fracture patterns while arthroplasty is indicated when a stable ORIF is not possible. Mobilization is postponed for about 2 weeks.
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Affiliation(s)
- Giovanni Vicenti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Davide Bizzoca
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Domenico Zaccari
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Claudio Buono
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Arianna Carlet
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Giuseppe Solarino
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Emmanuele Santolini
- Orthopedics and Trauma Unit, Emergency Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Enricomaria Lunini
- Orthopedics and Trauma Unit, ASST Lariana Ospedale Sant'Anna, Como, Italy
| | - Giacomo Zavattini
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Guglielmo Ottaviani
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy.
| | - Filippo Simone
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | | | - Roberto Rotini
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Franchini
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Biagio Moretti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
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Vicenti G, Bizzoca D, Pesare E, Grasso M, Ginestra W, Moretti B. Second and Third Pandemic Waves in Apulia: How COVID-19 Affected Orthopedic and Trauma Care-A Single-Center Study. J Clin Med 2022; 11:6526. [PMID: 36362754 PMCID: PMC9654803 DOI: 10.3390/jcm11216526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/24/2022] [Accepted: 10/31/2022] [Indexed: 07/30/2023] Open
Abstract
PURPOSE In orthopedics and traumatology, as a direct consequence of the COVID-19 first wave, there was a massive reorganization and a stop to all elective activities, which were postponed. In this study, we aimed to analyze the impact of the COVID-19 pandemic on orthopedic surgery in Apulia during the second wave, from March to June 2021 (when Apulia was under social distancing restrictions), and during the third wave, from September to December 2021 (when Apulia was under no restrictions). We compared these months to the same periods in 2019 for an evaluation of the surgical decrease during the pandemic period. METHODS We performed a retrospective analysis of major orthopedic procedures, day-surgery procedures and urgent procedures (trauma and non-traumatic amputation) performed during the second and third waves of the pandemic in our clinic, and we compared these data with the same procedures performed in the corresponding periods of 2019, before the pandemic. RESULTS Surgical activity was significantly decreased during both periods; the only increase in surgical activity in 2021 compared to 2019 was in total hip, knee and shoulder arthroplasty, with a surge of +7.69% registered in the period September-December 2021. CONCLUSIONS Longer waiting lists and limited healthcare resources were the big challenges for the orthopedic community, and they still represent a substantial issue to confront today.
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Affiliation(s)
- Giovanni Vicenti
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy
| | - Davide Bizzoca
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy
- PhD Program in Public Health, Clinical Medicine and Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Elisa Pesare
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy
| | - Michele Grasso
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy
| | - Walter Ginestra
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy
| | - Biagio Moretti
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy
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Hackl M, Lanzerath F, Ries C, Harbrecht A, Leschinger T, Wegmann K, Müller LP. Trans-fracture approach for ORIF of coronal shear fractures of the distal humerus. Arch Orthop Trauma Surg 2022; 143:2519-2527. [PMID: 35731264 PMCID: PMC10110670 DOI: 10.1007/s00402-022-04501-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Open reduction and internal fixation (ORIF) of comminuted coronal shear fractures of the distal humerus is challenging. When a concomitant lateral condyle fracture is present, it may be used for a trans-fracture approach to facilitate exposure and fracture reduction. This study aimed to investigate the frequency of lateral condyle fractures in coronal shear fractures of the distal humerus and analyze fracture reduction, fracture union and clinical results following ORIF through a trans-fracture approach. MATERIALS AND METHODS All adult patients who underwent treatment for an acute distal humerus fracture during a three-year period in our level-one trauma center were identified. All fractures were classified according to the Orthopaedic Trauma Association (OTA/AO) fracture classification system and all B3 fractures were classified according to the Dubberley classification. B3 fractures with a concomitant radial condyle fracture were identified. The clinical and radiological results, (Mayo Elbow Performance Score = MEPS, Visual Analogue Scale = VAS, range of motion), complications and revision surgeries were analyzed. RESULTS 53 patients (mean age 52 ± 19 years) were identified. 13 fractures (24.5%) were B3 fractures. Four of them (30.8%) had a concomitant radial condyle fracture. All of these patients underwent ORIF with headless cannulated compression screws and a (postero-)lateral locking plate through a trans-fracture approach. At a minimum follow-up of 24 months, the MEPS was 88 ± 12 points, the VAS was 2 ± 1 and the range of motion was 118° ± 12°. All fractures showed anatomic reduction. One patient developed partial avascular necrosis and underwent arthrolysis at 6 months. One patient underwent partial hardware removal and lateral collateral ligament bracing at 6 months. CONCLUSIONS Lateral condyle fractures are present in about one third of coronal shear fractures of the distal humerus. This injury can be used for a trans-fracture approach to facilitate exposure and to reliably achieve anatomic fracture reduction.
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Affiliation(s)
- Michael Hackl
- Faculty of Medicine, University of Cologne, Cologne, Germany. .,Center of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany.
| | - Fabian Lanzerath
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Center of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Christian Ries
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Harbrecht
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Center of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Tim Leschinger
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Center of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Kilian Wegmann
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Center of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Lars Peter Müller
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Center of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
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Teraura H, Gotani H, Sakanaka H. Modified Posterior Trans-olecranon Approach in Tri-vision for Dubberley Type 3B Coronal Shear Fractures of the Distal Humerus. Cureus 2022; 14:e25175. [PMID: 35607317 PMCID: PMC9123390 DOI: 10.7759/cureus.25175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/05/2022] Open
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Complications of articular distal humeral fracture fixation: a systematic review and meta-analysis. J Shoulder Elbow Surg 2021; 30:1957-1967. [PMID: 33711499 DOI: 10.1016/j.jse.2021.02.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/04/2021] [Accepted: 02/13/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Distal humeral fractures are relatively rare injuries in adults. Fractures that involve the articular surface can be particularly challenging to treat. Open reduction-internal fixation (ORIF) remains the preferred treatment for most intra-articular distal humeral fractures, depending on the degree of comminution and functional demands of the patient. Many surgical approaches, fixation techniques, and potential complications have been described in the literature; however, the relative incidence and associated characteristics of these complications have not been studied. The purpose of this study was to identify the prevalence of complications and reoperations after ORIF for intra-articular distal humeral fractures. We sought to provide practical guidance to surgeons and offer insights on the avoidance and prognosis of complications through a systematic review of the published literature over the past 20 years. METHODS We performed a systematic review and meta-analysis of studies reporting complications and reoperation rates after ORIF for intra-articular distal humeral fractures. Subgroup analysis was conducted for complication rates between type 13B and 13C fractures, olecranon osteotomy and non-osteotomy approaches, and parallel and perpendicular plating. RESULTS Eighty-three studies met the inclusion criteria (2362 elbows; 5 level II, 2 level III, and 76 level IV studies). The mean clinical follow-up period was 2.6 years. The majority of fractures were type C (83%), the remainder were type B (17%). Of the fractures, 71% were closed whereas 9% were open; this was not reported for 20%. The mean postoperative flexion arc was 110°. The overall complication rate was 53%, and the overall reoperation rate was 21%. Although a parallel plating approach resulted in a lower rate of fixation failure requiring revision (1% vs. 6%, P < .001), a perpendicular plating approach showed a significantly lower rate of overall complications (45% vs. 54%, P = .006). This was primarily driven by lower rates of wound dehiscence (0.1% vs. 5%, P < .001), neuropathy (9% vs. 13%, P = .03), and implant prominence (3% vs. 7%, P = .01). CONCLUSIONS This systematic review is the largest report of complications and reoperations of intra-articular distal humeral fractures after ORIF in the current literature. These results suggest that complications may be more frequent than previously understood. In contrast to prior small comparative studies, our study observed a significantly higher overall complication rate with parallel plating than with perpendicular plating. Perpendicular plating for intra-articular distal humeral fractures may be considered if adequate fixation and biomechanical stability can be achieved.
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Koëter M, van Hugten PPW, Emans PJ, Ten Bosch JA. Treatment of a coronal shear injury of the trochlea using a modified hedgehog-based technique through an anterior neurovascular interval approach: A case report. Int J Surg Case Rep 2021; 85:106211. [PMID: 34293656 PMCID: PMC8319752 DOI: 10.1016/j.ijscr.2021.106211] [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] [Received: 06/01/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Surgical treatment for dislocated trochlear shear injuries is recommended due to its articular nature. However, the surgical exposure is often limited and large cartilaginous fragments with lack of subchondral bone stock makes a stable fixation technically challenging. Rapid swelling of the traumatized cartilage induces a size misfit between the cartilage of the fragment and the defect site. The use of a "modified hedgehog"-based technique might be a solution in these cases. However, this technique has only been described in chondral shear lesions of the knee. CASE PRESENTATION A fifteen-year-old boy fell out of the still rings during gymnastics at school and suffered trauma to his elbow. A CT-scan of the right elbow showed a coronal shear injury of the trochlea with accompanied lateral condyle fracture of the humerus. The patient was treated throughout an anterior neurovascular approach with a modified hedgehog-based technique with triple fixation by creating an interlocking match of the cartilage, application of fibrin glue and additional screw fixation. CLINICAL DISCUSSION The anterior neurovascular interval approach provides a clear exposure of the fracture site which is useful for anatomic reduction and triple fixation. The subsequent modified hedgehog-based technique has only been described once in children with shear-off chondral fragments of the knee, without additional screw fixation. Adding a screw fixation of the fragment creates some collateral damage to the cartilage and might not be necessary in future cases. CONCLUSION The anterior neurovascular approach seems elegant and provides adequate exposure. Furthermore, a modified hedgehog-based technique delivers a stable triple fixation of the osteochondral fragment.
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Affiliation(s)
- M Koëter
- Departement of Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - P P W van Hugten
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - P J Emans
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - J A Ten Bosch
- Departement of Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
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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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Lu Y, Fu L, Ma T, Xu YB, Xu LP, Song Z, Fan S, Wang Q, Sun L, Xue HZ, Li Z, Zhang K, Liu DY, Ren C. Clinical Efficacy of Vertical or Parallel Technique of a Micro-Locking Plate for Treatment of Dubberley B-Type Capitellar Fractures. Orthop Surg 2021; 13:207-215. [PMID: 33426763 PMCID: PMC7862171 DOI: 10.1111/os.12880] [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: 06/14/2020] [Revised: 10/11/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the clinical efficacy of micro‐locking plate through vertical or parallel technique for treatment of Dubberley B‐type capitellar fractures. Methods A retrospective analysis was performed in 24 patients (17 males and seven females, with an average age of 44.9 years, range from 19 to 75 years) with capitellar fractures that were treated with micro‐locking plate using vertical or parallel technique between January 2016 to January 2019. The inclusion criteria include closed capitellar fracture, normal anterior elbow joint movement before injury, and recent capitellar fracture with injury within past 3 weeks. Fractures classified according to Dubberley included four cases of type IB, eight cases of type IIB, and 12 cases of type IIIB. Radiographic evaluation was performed. Surgery time, blood loss, range of motion of the elbow, forearm rotation, and complications were recorded. Elbow joint function was evaluated by Mayo Elbow Performance Score (MEPS). Results The mean follow‐up period was 19.6 months (range, 12–36 months). The average clinical healing time for fractures was 11.2 ± 3.2 weeks (range, 8–20 weeks). Fracture united in all patients. Two patients showed slight delayed union, but union was achieved eventually. The mean time from injury to surgery was 6.3 ± 3.1 days (range, 2–15 days). The average surgical time was 68.1 ± 11.5 min (range, 50–90 min), and the mean blood loss was 75.2 ± 26.5 mL (range, 40–120 mL). The mean range of flexion was 122.5° ± 10.5°(range, 95°–140°). The mean range of extension was 8.5° ± 5.8°(range, 0°–20°). The mean range of pronation was 79.7° ± 8.0°(range, 65°–90°). The mean range of supination was 80.5° ± 7.1°(range, 60°–90°). The mean MEPS at final follow‐up was 89.8 ± 9.0 (range, 60–100). Based on the MEPS, 18 (75%) patients had excellent, five (20.8%) patients had good, and one (4.2%) patient had fair. None of the 24 patients suffered vascular or nerve injury. One patient showed superficial infection, which was treated with surgical dressing. Conclusions The vertical or parallel technique of the micro‐locking plate is an excellent method for treating Dubberley B‐type capitellar fractures.
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Affiliation(s)
- Yao Lu
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China.,Bioinspired Engineering and Biomechanics Center (BEBC), The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Lei Fu
- Orthopaedics Institute of Chinese PLA, 80th Hospital, Weifang, China
| | - Teng Ma
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China.,Bioinspired Engineering and Biomechanics Center (BEBC), The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Yi-Bo Xu
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Li-Ping Xu
- Orthopaedics Institute of Chinese PLA, 80th Hospital, Weifang, China
| | - Zhe Song
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Shan Fan
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Qian Wang
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Liang Sun
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Han-Zhong Xue
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zhong Li
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Kun Zhang
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - De-Yin Liu
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Cheng Ren
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
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11
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Capitellum fractures: Treatment with headless screws and outcomes. Jt Dis Relat Surg 2020; 31:291-297. [PMID: 32584728 PMCID: PMC7489174 DOI: 10.5606/ehc.2020.72821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/08/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives
This study aims to present the results of 21 patients with capitellum fractures treated with open reduction and headless screws by a single experienced surgeon. Patients and methods
Twenty-one patients (13 males, 8 females; mean age 39 years; range, 18 to 63 years) who were admitted to our clinic between June 2011 and January 2018 with the diagnosis of capitellum fracture and followed-up for a mean period of 45 months (range, 12 to 90 months) were included in this retrospective study. The fractures were fixed with headless cannulated screws by a single surgeon. Results
The mean range of motion was 102° (range, 65° to 140°) during flexion-extension and 165° (range, 130° to 180°) during supination-pronation. The mean preoperative visual analog scale (VAS) score was 8.5 (range, 6 to 10), whereas the mean postoperative VAS score was 2.2 (range, 0 to 6). According to the Mayo Elbow Performance score, nine patients were evaluated as excellent, six patients as good, four patients as fair, and two as poor. The mean Quick-Disabilities of the Arm, Shoulder and Hand score was 25.1 (range, 4 to 57). Avascular necrosis developed in three patients (14%) and heterotopic ossification was detected in one patient (4%). Conclusion Capitellum fractures are difficult to diagnose and treat, and good results can only be achieved by an accurate diagnosis, careful surgical technique, and stable fixation. Larger and more comprehensive studies are required to establish a generalization and more accurate inferences on this limitedly studied subject.
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Song Z, Wang Q, Ma T, Wang C, Yang N, Xue H, Li Z, Zhu Y, Zhang K. Anti-sliding plate technique for coronal shear fractures of the distal humerus. J Orthop Surg Res 2020; 15:18. [PMID: 31952529 PMCID: PMC6969457 DOI: 10.1186/s13018-019-1466-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/08/2019] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The purpose of this study is to discuss the surgical strategy, technical feasibility, and clinical efficacy of coronal shear fractures of the distal humerus using the anti-sliding plate technique. METHODS Fifty-two patients (35 males and 17 females) were treated with the anti-sliding plate technique in our hospital from January 2012 to January 2017. The average age of the patients was 40.4 years. They were classified according to the Dubberley classification system and treated with the anti-sliding plate technique. The long-term functional scores represented by the Mayo Elbow Performance Index and complications were evaluated. RESULTS Fractures were classified as follows: 11 type-IA, 5 type-IB, 16 type-IIA, 4 type-IIB, 13 type-IIIA, and 3 type-IIIB according to the Dubberley classification system. All patients were treated with open reduction and internal fixation by the extensile lateral approach and completed a clinical and radiographic follow-up (average, 17.6 months). The average Mayo elbow performance score was 90.6 points, with 36 excellent, 11 good, and 5 fair results. The average range of movement of the elbow joint was 3° (0-15°) for extension and 136° (90-150°) for flexion. CONCLUSIONS The anti-sliding plate technique follows basic AO principles and neutralizes the shearing force combined with lag screws and/or Kirschner wires after the anatomic reduction of the fracture. It allows for the stable internal fixation of the fracture, which is critical for early mobilization and a good functional outcome. LEVEL OF EVIDENCE Level IV, Case Series, Treatment Study.
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Affiliation(s)
- Zhe Song
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Qian Wang
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Teng Ma
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Chen Wang
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Na Yang
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Hanzhong Xue
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Zhong Li
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Yangjun Zhu
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Kun Zhang
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China.
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Garg S, Sain A, Sharma V, Farooque K, Rangaswamy N. Functional Outcome of a Coronal Shear Fracture of the Capitellum Managed by Herbert Screw Fixation Using the Anterolateral Surgical Approach. Cureus 2020; 12:e6578. [PMID: 31956467 PMCID: PMC6946593 DOI: 10.7759/cureus.6578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Fractures of the capitellum, particularly coronal shear fractures, are difficult to manage. The challenges are adequate surgical exposure, proper anatomic reduction, and stable fixation of these fractures. Our study included 10 patients with a coronal shear fracture of the capitellum without any involvement of the posterior condyle. All patients underwent open reduction and Herbert screw fixation using the anterolateral approach, with good functional outcome. In our opinion, this is a good option for the treatment of coronal shear fractures of the capitellum.
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Affiliation(s)
- Sitender Garg
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, IND
| | - Arnab Sain
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, IND
| | - Vijay Sharma
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, IND
| | - Kamran Farooque
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, IND
| | - Namith Rangaswamy
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, IND
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