1
|
Holte AJ, Dean RE, Chang G. Distal humerus fractures: review of literature, tips, and tricks. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:639-646. [PMID: 39157236 PMCID: PMC11329030 DOI: 10.1016/j.xrrt.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Affiliation(s)
- Andrew J. Holte
- Department of OrthopedicSurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Ryan E. Dean
- Department of OrthopedicSurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Gerard Chang
- Department of OrthopedicSurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| |
Collapse
|
2
|
Yadav AS, Kollapaneni SS, Wallace D, Bryan CA. Intercondylar T-Type Distal Humerus Fracture in a 10-Year-Old: A Case Report. JBJS Case Connect 2024; 14:01709767-202409000-00008. [PMID: 38991091 DOI: 10.2106/jbjs.cc.24.00134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
CASE A 10-year-old, postmenarchal girl presented to the emergency department with a closed, displaced, intercondylar T-type distal humerus fracture. Open reduction and internal fixation was performed 3 days following initial presentation. The patient healed but experienced elbow stiffness in the 7 months following the procedure. Implant removal and capsular release were performed at that time. At the 31-month follow-up, the patient reported satisfactory elbow functionality. CONCLUSION There is limited literature available discussing optimal management and associated outcomes of intercondylar T-type distal humerus fractures in the young-adolescent population. This report presents a possible method for management of the initial injury and the most common associated complication.
Collapse
Affiliation(s)
- Aditya S Yadav
- Children's Hospital of Georgia, Augusta University Health, Augusta, Georgia
- Department of Orthopaedics, Medical College of Georgia, Augusta, Georgia
| | - Sai Suraj Kollapaneni
- Children's Hospital of Georgia, Augusta University Health, Augusta, Georgia
- Department of Orthopaedics, Medical College of Georgia, Augusta, Georgia
| | - Doyle Wallace
- Children's Hospital of Georgia, Augusta University Health, Augusta, Georgia
- Department of Orthopaedics, Medical College of Georgia, Augusta, Georgia
| | - Cory A Bryan
- Children's Hospital of Georgia, Augusta University Health, Augusta, Georgia
- Department of Orthopaedics, Medical College of Georgia, Augusta, Georgia
| |
Collapse
|
3
|
Fares MY, Boufadel P, Koa J, Vadhera AS, Singh J, Abboud JA. Top fifty cited articles on humeral fractures. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:153-160. [PMID: 38706674 PMCID: PMC11065750 DOI: 10.1016/j.xrrt.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Background Humeral fractures (HF) are common orthopedic pathologies. Reviewing the content and quality of influential literature over time is important to advance scientific research regarding a specific topic. This study aims to explore and appraise the fifty most cited HF studies that had been published in orthopedic literature. Methods The Web of Science database was used to conduct a systematic search for articles pertaining to HF. Articles were sorted out in descending order of citations and were included based on their relevance to HF. Data and metrics of the included studies were recorded. The methodological quality of the studies was assessed using the Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-randomized Studies criteria. Statistical analysis was conducted to explore any significant relationships between the date of publication and other relevant variables. Results Included articles (N = 50) were published between 1959 and 2015, with a total of 14,864 accumulated citations. Europe and North America contributed to all but one of the included studies. The Journal of Bone and Joint Surgery contributed to the highest number of included articles with 27 articles (54%). The proximal humerus was the most commonly explored HF location in our study (72%). The average MCMS and Methodological Index for Non-randomized Studies scores were reported to be 64.6 and 10.4, respectively, and the majority of articles (52%) were considered level four case series. Year of publication was found to have a positive correlation with increasing level of evidence(r = -0.301, P = .044), citation density (r = 0.734, P < .001), and MCMS score (r = 0.41, P = .01). Conclusion The level of evidence, MCMS scores, and citation density of influential HF literature has been increasing with time, reflecting the increasing effort and work being put in that field. While the findings seem encouraging, additional high-quality research is needed to help achieve better treatment strategies and outcomes.
Collapse
Affiliation(s)
- Mohamad Y. Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Peter Boufadel
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Jonathan Koa
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Amar S. Vadhera
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Jaspal Singh
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Joseph A. Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| |
Collapse
|
4
|
Worden JA, Gabig AM, Cooke HL, Gottschalk MB, Wagner ER. The Top 100 Classical and Contemporary Papers on Elbow Surgery: A Trend Analysis of Elbow Surgery Literature. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00002. [PMID: 38421605 PMCID: PMC10906574 DOI: 10.5435/jaaosglobal-d-23-00287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Bibliometric analyses provide an aggregate of the most frequently cited literature in a given field. The purpose of this study was to analyze the top 100 most-cited classical and contemporary papers relating to elbow surgery to serve as a reference for surgeons and trainees for educational and research purposes. METHODS A search was conducted for all papers containing the term "elbow" in the categories Orthopedics, Surgery, and Sports Science in the Clarivate Web of Science. Classical papers were those published from 1980 to 2009, and contemporary papers were those published from 2010 to 2019. Articles were assessed by country of origin, authors and their credentials, parent journal, level of evidence, and topic. RESULTS Citation frequency ranged from 86 to 867. Among the classical group, there were more level IV papers compared with level I papers; however, the opposite was true in the contemporary group. The most common topic in the classical group was elbow anatomy and function, and the most common topic in the contemporary group was lateral epicondylitis and medial epicondylitis and associated therapies. DISCUSSION This bibliometric analysis serves to help guide surgeons and trainees on the highly cited articles and important topics in elbow surgery, demonstrating a shift to prospective randomized controlled trials in recent years. LEVEL OF EVIDENCE Level V (Systematic Review with Level V as Lowest LOE).
Collapse
Affiliation(s)
- Jacob A. Worden
- From the Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA (Mr. Worden), and the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Dr. Gabig, Ms. Cooke, Dr. Gottschalk, and Dr. Wagner)
| | - Andrew M. Gabig
- From the Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA (Mr. Worden), and the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Dr. Gabig, Ms. Cooke, Dr. Gottschalk, and Dr. Wagner)
| | - Hayden L. Cooke
- From the Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA (Mr. Worden), and the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Dr. Gabig, Ms. Cooke, Dr. Gottschalk, and Dr. Wagner)
| | - Michael B. Gottschalk
- From the Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA (Mr. Worden), and the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Dr. Gabig, Ms. Cooke, Dr. Gottschalk, and Dr. Wagner)
| | - Eric R. Wagner
- From the Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA (Mr. Worden), and the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Dr. Gabig, Ms. Cooke, Dr. Gottschalk, and Dr. Wagner)
| |
Collapse
|
5
|
Garg R, Vezeridis PS, Monica JT, Mudgal CS. The "Bag of Bones" Treatment of Comminuted Intra-articular Distal Humerus Fractures in the Elderly. Hand (N Y) 2024:15589447231218300. [PMID: 38179992 DOI: 10.1177/15589447231218300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Extensively comminuted intra-articular distal humerus fractures in the elderly present a challenging therapeutic dilemma. The purpose of this study was to investigate the results of nonoperative treatment of these fractures in a select subset of patients. METHODS Patients treated with nonoperative management for a comminuted intra-articular distal humerus fracture between 2007 and 2018 were reviewed. Patients were administered 3 elbow-specific functional outcomes instruments. RESULTS A total of 8 patients (2 men, 6 women) were treated with brief immobilization followed by early range of motion. All had fractures with extensive comminution of the articular surface such that open reduction and internal fixation was not feasible. Average age was 70 years. At an average of 33 months postinjury, average flexion was 124°, and extension was -27°, with full forearm rotation. No patients required pain medications at the latest follow-up. At 33 months of follow-up, the average Mayo Elbow Performance Score was 92/100 (100 optimal), Oxford Elbow Score was 43/48 (48 optimal), and Quick Disabilities of the Arm, Shoulder, and Hand Score was 10/100 (0 optimal). All patients were satisfied with the nonsurgical treatment that they received. CONCLUSIONS Nonoperative treatment for comminuted intra-articular distal humerus fractures results in acceptable functional outcome in elderly patients and should be considered when the fracture is not amenable to internal fixation and in lower-demand patients with higher surgical risk.
Collapse
Affiliation(s)
- Rohit Garg
- Massachusetts General Hospital, Boston, USA
| | | | | | | |
Collapse
|
6
|
Feinstein SD, Paterno AV, Allen AD, Jewell E, Wright ST, Draeger RW. Techniques and Fixation of Olecranon Osteotomy: A Systematic Review. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:643-649. [PMID: 37790831 PMCID: PMC10543770 DOI: 10.1016/j.jhsg.2023.04.001] [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: 11/08/2022] [Accepted: 04/12/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose We aimed to characterize the incidence of complications regarding olecranon osteotomy, looking more specifically at the type of osteotomy and the fixation construct used to repair the osteotomy. Methods In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search was performed. A study was included if it was an adult clinical study, a transverse or chevron olecranon osteotomy was performed, and the study explicitly states the fixation construct used to repair the osteotomy. A quality assessment was performed in each study prior to data extraction. Results We included 39 studies with a total of 1,445 patients. Most studies included patients who were being treated primarily for a distal humerus fracture. The overall incidence of delayed union was 27/643 (4.2%), with a higher rate in transverse osteotomy than in chevron osteotomy (5/49 (10.2%) vs 22/595 (3.7%)). Nonunion occurred in 43/811 (5.4%) of patients, with a higher rate in transverse osteotomy (6/73 (8.2%) vs. 37/712 (5.2%)). Implant failure or loss of reduction occurred in 44/746 (5.9%) of patients, with a higher rate in transverse osteotomy (11/49 (22.4%) vs 33/688 (4.8%)). The removal of implants occurred in 236/1078 (21.9%) of all patients, with the highest rate in those studies that used plate fixation 44/99 (44.4%). Conclusions Compared with chevron osteotomy, patients who underwent transverse osteotomy had a higher incidence of delayed union, nonunion, and implant failure or loss of reduction requiring revision surgery. The incidence of implant removal indicates that patients should be informed that nearly half of the osteotomy fixed with a plate was removed after implantation. Type of study/level of evidence Therapeutic III.
Collapse
Affiliation(s)
- Shawn D. Feinstein
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| | - Anthony V. Paterno
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| | - Andrew D. Allen
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| | - Emily Jewell
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| | - Sarah T. Wright
- University Libraries, University of North Carolina, Chapel Hill, NC
| | - Reid W. Draeger
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| |
Collapse
|
7
|
Saini R, Sharma A, Rathore KS, Sidhu SS. Clinical and Functional Outcomes of Anatomical Plating in Distal Humerus Fractures in Adults. Cureus 2023; 15:e35581. [PMID: 37007319 PMCID: PMC10062419 DOI: 10.7759/cureus.35581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/04/2023] Open
Abstract
Background Overall, 2% of all adult fractures are attributed to fractures of the distal humerus, including both supracondylar and intercondylar fractures. According to recent studies, stable fixation with anatomical reduction of intra-articular fragments and early mobilization is required for best outcomes. This study included patients with distal end humerus fractures treated by open reduction and internal fixation (ORIF) with anatomical locking plates and evaluated their clinical outcomes. Methodology This prospective study was conducted at a medical college teaching hospital in southern Rajasthan, India. In total, 20 adult patients with distal end humerus fractures who presented to the orthopedic outpatient department or casualty were admitted. Patients were treated by ORIF with anatomical locking plates, followed up, and evaluated for clinical and functional outcomes. Results Using the Mayo Elbow Performance Score, out of 20 cases, excellent results were noted in five patients, good results in seven patients, fair results in six patients, and poor results in two patients. Conclusions Locking plates are reliable and effective management options for distal humerus fractures. As locking plates are strong and rigid, the period of immobilization can be decreased. Early mobilization helps in preventing joint stiffness and fixed deformity of the joint.
Collapse
|
8
|
Muacevic A, Adler JR, Shanthappa AH. Functional Outcome of Distal Humerus Fractures Treated With Open Reduction and Internal Fixation With Bicolumnar Plating in a Tertiary Care Setting. Cureus 2023; 15:e33540. [PMID: 36779108 PMCID: PMC9907393 DOI: 10.7759/cureus.33540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
Introduction Fractures of the distal humerus in the adult comprise approximately one-third of all humeral fractures. Over the past 20 years, nonoperative treatment for these fractures has been substituted by anatomic reduction and internal fixation based on the Association for Osteosynthesis (AO)/Association for the Study of Internal Fixation (ASIF) philosophy of plate fixation which resulted in early mobilization and superior performance. Pre-contoured, anatomically designed locking plates are anticipated to offer sufficient stability, permit early elbow range of motion, and safeguard the soft tissue. In comparison to any other joint, the elbow's good anatomical alignment, perfect stability, and early mobilization principles are of utmost significance. Methodology A hospital-based consecutive case series of distal humerus fracture patients managed surgically with bicolumnar plating at R.L. Jalappa Hospital Centre, from June 2021 to June 2022 was chosen. Patients were clinically assessed by measuring the range of motion of the elbow with a goniometer. A six-week post-operative review was the first one. Routine checkups were scheduled every four weeks up until there was evidence of fracture consolidation radiologically. Clinically Mayo Elbow Performance score (MEPS) was analyzed at the end of six-month follow-up and tabulated. Institutional Ethical committee permission was taken prior to the study. Results In the study, 47% of cases had an Excellent MEPS followed by 33% of patients having a good MEPS and 13% having a Fair MEPS rating. Only 7% of patients had poor MEPS. Among the patients, 33.3% had 90 MEPS followed by 16.6% cases had 85 MEPS. Only 2 patients had 55 MEPS in the study. The fracture pattern configuration based on AO classification in our study was C2>C1>C3>A2.3=A3.3. Conclusion Due to an increase in road traffic accidents, complicated distal humeral fractures are becoming more common among younger people. In terms of stability and arc of motion, excellent to good functional outcomes were attained in around 80% of the study group. Because of the extremely stable build system produced by parallel plating, there have been no reported instances of implant failure or non-union.
Collapse
|
9
|
Kavi S, Patel I, Amin T, Makwana V, Prajapati M, Patel A, Modi D. Results of intra-articular distal humerus fracture treated with open reduction and internal fixation. JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2023. [DOI: 10.4103/jodp.jodp_61_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
|
10
|
Han SH, Park JS, Baek JH, Kim S, Ku KH. Complications associated with open reduction and internal fixation for adult distal humerus fractures: a multicenter retrospective study. J Orthop Surg Res 2022; 17:399. [PMID: 36045372 PMCID: PMC9429783 DOI: 10.1186/s13018-022-03292-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background Open reduction and plate fixation are the preferred treatment options for most distal humerus fractures in adults. However, it is often challenging for orthopedic surgeons because of the complex anatomy and the difficulty in achieving stable fixation. This multicenter study aimed to analyze the complication types and rates of patients with distal humerus fractures treated with open reduction and plate fixation, and compare the results with those found in the literature. In addition, we describe the clinical outcomes.
Methods This retrospective multicenter study was conducted between September 2001 and March 2021 and included data from four hospitals. In total, 349 elbows underwent surgical treatment at these hospitals during the study period. Patients > 17 years of age who were treated by plate fixation were included, and patients who were treated by other fixation methods were excluded. A total of 170 patients were included in the study. The following types of complications were investigated: (1) nerve related; (2) fixation and instrument related; (3) osteosynthesis related; (4) infection; and (5) others.
Results The following complications were found: (1) 26 (15.3%) cases of postoperative ulnar nerve symptoms; 4 (2.4%) of postoperative radial nerve symptoms; (2) one (0.6%) case of screw joint penetration and screw loosening; and eight (4.7%) cases of hardware removal due to instrument skin irritation; (3) seven (4.1%) cases of nonunion; (4) two (1.2%) and four (2.2%) cases of superficial and deep infection, respectively, and seven (3.9%) cases of wound complication; and (5) 37 (21.8%) cases of heterotrophic ossification, 79 (46.5%) cases of elbow stiffness (did not achieve functional range of motion [ROM]), and 41 (24.1%) cases of osteoarthritis over Broberg and Morrey Grade I. Paradoxically, the postoperative ulnar nerve symptoms were more frequent in the prophylactic ulnar nerve anterior transposition group. However, this difference was not statistically significant (p = 0.086). The mean ROM was 123.5° flexion to 9.5° extension. The average Disabilities of the Arm, Shoulder and Hand (DASH) score was 14.5 ± 15.6. Conclusions Open reduction and plate fixation for distal humeral fractures is a reasonable treatment option with acceptable complication rates and favorable clinical outcomes. Surgeons must be vigilant about ulnar nerve complications. Level of Evidence Therapeutic Level III. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03292-1.
Collapse
Affiliation(s)
- Soo-Hong Han
- Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea
| | - Jin Sung Park
- Division of Hand & Wrist Surgery and Microsurgery, Department of Orthopedic Surgery, Yeson Hospital, 206, Bucheon-ro, Bucheon-si, Gyeonggi-do, 14555, Republic of Korea
| | - Jong Hun Baek
- Department of Orthopedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of medicine, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Segi Kim
- Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea
| | - Ki Hyeok Ku
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892, Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea.
| |
Collapse
|
11
|
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.
Collapse
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:
| |
Collapse
|
12
|
Haglin JM, Kugelman DN, Lott A, Belayneh R, Konda SR, Egol KA. Intra-articular Distal Humerus Fractures: Parallel Versus Orthogonal Plating. HSS J 2022; 18:256-263. [PMID: 35645650 PMCID: PMC9096995 DOI: 10.1177/15563316211009810] [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: 09/22/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023]
Abstract
Background: Dual-plating osteosynthesis is the standard treatment for Orthopedic Trauma Association (OTA)-type 13-C distal humerus fractures. However, optimal plate position is debated. Purpose: The purpose of this study was to evaluate dual-plate positioning following intra-articular distal humerus fracture repair by comparing outcomes between patients plated in parallel and those plated orthogonally following open-reduction, internal-fixation (ORIF) of intra-articular distal humerus fractures. Methods: All OTA-type 13-C intra-articular distal humerus fractures treated operatively at our institution over a 10-year period were reviewed. Clinical outcomes and complications were compared between those plated in parallel and those plated orthogonally. Data were analyzed using independent-samples t-tests, Mann-Whitney U tests, chi-square tests, and Fisher's exact tests. Results: A total of 69 patients met inclusion criteria. Mean follow-up among this cohort was 19.3 months; 45 (64.8%) patients had orthogonal dual plating, and 24 (35.2%) had parallel plating. Groups did not differ with respect to demographics or duration of follow-up. Clinically, there were no significant differences in time to union, elbow arc of motion at any time point, or patient Mayo Elbow Performance Index (MEPI) scores at final follow-up. Furthermore, there were no differences in complications. Conclusion: Parallel and orthogonal plating following ORIF of distal humerus fractures with modern, contoured locking compression plates had similar outcomes in this study. This study represents the largest comparative series in the literature at the time of its writing. Both techniques may be considered when deciding on dual-plating technique for treating intra-articular distal humerus fractures.
Collapse
Affiliation(s)
- Jack M. Haglin
- Department of Orthopedic Surgery, NYU
Langone Orthopedic Hospital, New York, NY, USA
| | - David N. Kugelman
- Department of Orthopedic Surgery, NYU
Langone Orthopedic Hospital, New York, NY, USA
| | - Ariana Lott
- Department of Orthopedic Surgery, NYU
Langone Orthopedic Hospital, New York, NY, USA
| | - Rebekah Belayneh
- Department of Orthopedic Surgery, NYU
Langone Orthopedic Hospital, New York, NY, USA
| | - Sanjit R. Konda
- Department of Orthopedic Surgery, NYU
Langone Orthopedic Hospital, New York, NY, USA
| | - Kenneth A. Egol
- Department of Orthopedic Surgery, NYU
Langone Orthopedic Hospital, New York, NY, USA,Kenneth A. Egol, MD, Department of
Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY 10003, USA.
| |
Collapse
|
13
|
Sudah SY, Puzzitiello RN, Nasra MH, Moverman MA, Pagani NR, Guss MS, Menendez ME. Nonoperative treatment of distal humerus fractures in the elderly yields satisfactory functional outcomes and low conversion to delayed surgery: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:96-102. [PMID: 37588281 PMCID: PMC10426674 DOI: 10.1016/j.xrrt.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Distal humerus fractures (DHFs) pose a treatment challenge in elderly patients. We sought to systematically review and report the clinical outcomes of the nonoperative approach (eg, "bag of bones") for the treatment of these injuries and the rate of conversion to delayed surgery. Methods A comprehensive review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was conducted. Studies involving outcomes after nonoperative treatment of DHF in patients >65 years of age were included from 1985 to present. Data regarding patient age, DHF type, nonoperative treatment method, complications, conversion to delayed surgery, range of motion, union rate, and surgeon- and patient-reported outcome measures were extracted. Results A total of five studies met inclusion criteria (all level IV evidence), yielding a total of 143 patients (mean age: 73.5 years to 87.4 years) with 7.1 months to 55 months of follow-up. The mean Mayo Elbow Performance Index scores were good to excellent across several studies (range 83-93.1). Multiple studies reported good range of motion (mean arc of motion: 81 to 106 degrees) and low levels of upper extremity disability (mean Quick Disability of the Arm-Shoulder-Hand scores: 31.3 to 38.5) at the final follow-up. The rate of conversion to total elbow arthroplasty and operative fixation ranged from 0% to 7.5% and 0% to 5%, respectively. Conclusion Nonoperative management of distal humerus fractures in the elderly seems to be associated with acceptable functional outcomes and low rates of delayed surgery. This information is important for patient counseling and treatment decision-making.
Collapse
Affiliation(s)
- Suleiman Y. Sudah
- Department of Orthopedic Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Richard N. Puzzitiello
- Department of Orthopedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | | | - Michael A. Moverman
- Department of Orthopedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Nicholas R. Pagani
- Department of Orthopedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Michael S. Guss
- Department of Orthopedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA
| | - Mariano E. Menendez
- Department of Orthopedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| |
Collapse
|
14
|
Bäcker HC, Freibott CE, Swart E, Perka C, Jobin CM, Rosenwasser MP. A novel treatment for prevention of post-traumatic elbow stiffness using onaBotulinum toxin type A: a prospective placebo controlled randomized trial. Acta Orthop Belg 2021. [DOI: 10.52628/87.3.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Approximately 30% of all upper extremity fractures are elbow fractures which may result elbow stiffness. This study aimed to investigate the efficacy of onaBotulinum Toxin type A injection to prevent post-traumatic pain and elbow-stiffness. All patients were included who presented to a single surgeon with supracondylar/ intraarticular distal humerus fractures, proximal ulna and radius fractures. The study was developed in a randomized placebo controlled study between 2003-2007. The Disabilities of the Arm, Shoulder, and Hand (DASH) score as well as the arc-of-motion (AOM) were assessed after three, six, twelve-months and final follow up for evaluation. Of the 31-patients included, 15-patients (48.4%) received Botox injections. In all patients no complication was observed when injecting a dosage 100-units for the brachialis and biceps brachii muscles. Furthermore, it was an effective method to prevent post-traumatic elbow stiffness, lasting six- months. Significant differences in DASH, VAS-score and ROM after three-months between the Botox and control group (DASH 21.6±11.0 vs. 55.3±11.0 ; VAS 1.2±5.2 vs. 5.7±21.9 ; ROM 103±7.6 vs. 73±6.3 ; p>0.05) were identified in the prospective group. Botulinum toxin is a safe, reliable and effective treatment to prevent post-traumatic elbow stiffness.
Our study demonstrates improved early range-of- motion (p<0.05), better extension after 6 weeks and improved functional outcome including VAS and DASH score (p<0.05).
Collapse
|
15
|
Dehghan N, Nauth A, Hall J, Vicente M, McKee MD, Schemitsch EH. In Situ Placement Versus Anterior Transposition of the Ulnar Nerve for Distal Humerus Fractures Treated With Plate Fixation: A Multicenter Randomized Controlled Trial. J Orthop Trauma 2021; 35:465-471. [PMID: 33675624 DOI: 10.1097/bot.0000000000002066] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare clinical scores and electrodiagnostic evidence of ulnar neuropathy, between ulnar nerve mobilization and placement back in the cubital tunnel versus anterior transposition, during plate and screw fixation of a bicolumnar fracture of the distal humerus. DESIGN Multicenter randomized controlled trial. SETTING Eight tertiary care centres in Canada. PATIENTS Fifty-eight patients with distal humerus fractures undergoing plate fixation of both columns were recruited and randomized. INTERVENTION All patients underwent bicolumnar plate fixation for an acute, displaced fracture of the distal humerus with identification, mobilization, and protection of the ulnar nerve as part of the surgical approach. At the conclusion of the procedure, they were randomized to either (1) replacing the nerve in situ in the cubital tunnel or (2) anterior transposition. MAIN OUTCOME MEASUREMENTS The primary outcome was the Gabel & Amadio rating scale for ulnar neuropathy. Secondary outcomes included a functional outcome score (Mayo Elbow Performance Score), disabilities of the arm, shoulder and hand instrument, 2-point discrimination, nerve conduction testing, complications, and secondary surgeries. RESULTS Thirty-one patients were randomized to in situ placement and 27 to anterior transposition. The mean age was 53 years, and 60% were women. There was no difference between the 2 groups with regards to age, gender, body mass index, smoking, diabetes, injury characteristics, time to operation, length of operation, or surgical approach. There was no difference in outcome between the 2 groups at any time point with regards to Gabel & Amadio ulnar neuropathy scores, Mayo Elbow Performance Score, disabilities of the arm, shoulder and hand instrument, or 2-point discrimination. The incidence of ulnar nerve dysfunction, as measured by use of the Gabel & Amadio ulnar neuropathy score, was poor in both groups acutely; however, there was significant improvement at 12 months postoperatively (6.0-7.8, P < 0.001). CONCLUSIONS This study was unable to demonstrate any significant difference in outcomes when comparing ulnar nerve mobilization and in situ placement and anterior subcutaneous transposition after bicolumnar plate fixation of a distal humerus fracture. Either strategy for managing the ulnar nerve is acceptable and can be used at the discretion of the treating surgeon. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Niloofar Dehghan
- The CORE Institute, Phoenix, AZ
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Aaron Nauth
- Division of Orthopaedics, Department of Surgery, University of Toronto and St. Michael's Hospital, Toronto, ON, Canada ; and
| | - Jeremy Hall
- Division of Orthopaedics, Department of Surgery, University of Toronto and St. Michael's Hospital, Toronto, ON, Canada ; and
| | - Milena Vicente
- Division of Orthopaedics, Department of Surgery, University of Toronto and St. Michael's Hospital, Toronto, ON, Canada ; and
| | - Michael D McKee
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Emil H Schemitsch
- Division of Orthopaedics, Department of Surgery, University of Western Ontario, London, ON, Canada
| |
Collapse
|
16
|
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: 22] [Impact Index Per Article: 7.3] [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.
Collapse
|
17
|
Karslioglu B. Transverse olecranon osteotomy with Gigli saw: A fast and reliable technique. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2021. [DOI: 10.25083/2559.5555/6.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective. Distal humerus fractures constitute of approximately 2% of all fractures and 30% of elbow fractures. Olecranon osteotomy provides excellent exposure of distal humerus and articular surface. In this study, we aimed to compare transverse osteotomy with gigli saw and classical chevron osteotomy techniques in terms of osteotomy duration and clinical results. Materials and Methods. 40 elbows of 40 patients with Type B intraarticular distal humerus fractures according to AO classification were included in our study. Patients were divided into 2 groups as transverse or chevron osteotomy groups. Patients were evaluated in terms of intraoperative osteotomy time, postoperative time to union, range of motion in the elbow joint and Quick Dash scores at 6th, 12th and 24th months. Results. The mean age of the patients was 45.6 years (19-62). 40% of the patients (8 patients) in the Chevron group had more than 2 mm stepping at articular surface, while this rate was 10% (2 patients) in the gigli saw group. Union was obtained in all patients for both techniques. There was no significant difference between the mean QuickDASH scores and range of motion of the elbow joints except flexion in both groups. Range of motion of flexion was statistically better in the gigli saw group (p<0.05). Conclusions. Transverse osteotomy technique significantly reduces osteotomy and fixation time and will not cause problems in fracture union. It may be preferred because it is simpler and faster to apply than chevron osteotomy and because intra-articular stepping is less common.
Collapse
|
18
|
Meldrum A, Kwong C, Archibold K, Cinats D, Schneider P. Olecranon Osteotomy Implant Removal Rates and Associated Complications. J Orthop Trauma 2021; 35:265-270. [PMID: 33086235 DOI: 10.1097/bot.0000000000001979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study reports on olecranon osteotomy implant removal rates, fixation types, and associated complications. DESIGN Multicentre case series. SETTING Patients were identified through an electronic medical database at one Level 1 trauma center and three Level 2 trauma centers. PATIENTS Two hundred thirty-five patients were identified through the database, of which 92 patients met inclusion criteria. INTERVENTION Patients underwent olecranon osteotomy for fixation of distal humerus fractures and the implant used was at the surgeon's discretion. MAIN OUTCOME MEASUREMENT Implant removal rate. RESULTS Thirty-four of 92 (37.0%) patients underwent removal of implant from their olecranon osteotomy. Implant removal rates were as follows: 28 of the 63 patients for tension band wiring (TBW) (44.4%), 6 of the 18 patients for plates (33.3%), 0 of the 1 patient for cable-pin, and 0 of the 10 patients for osteotomies fixed with a screw fixation. Screw fixation was removed less frequently than TBW (P = 0.01). Screws were less commonly removed than all other fixation types (P = 0.01). TBWs (28/63) were more commonly removed than all other implants (6/29) (P < 0.05). The nonunion rate for olecranon osteotomies was 3.3%. TBWs (18/18) are more likely to be removed for implant irritation than plates. TBWs had an odds ratio of 3.29 for requiring implant removal if they were left >1 mm off of the olecranon tip. CONCLUSION In this study, 34 of the 92 (37%) patients undergoing an olecranon osteotomy for treatment of a distal humerus fracture required removal of olecranon implant. Screw fixation (0/10) was found to be removed less frequently than TBW fixation 28 of the 63 patients (44.4%). LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Alexander Meldrum
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Cory Kwong
- Southern California Orthopaedic Institute, University of Los Angeles, Los Angeles, CA
| | | | - David Cinats
- Department of Orthopedics, SUNY Upstate Medical University, Syracuse, NY; and
| | - Prism Schneider
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Comparison of double screw fixation versus tension-band fixation after olecranon osteotomy for complex distal humerus fractures. Orthop Traumatol Surg Res 2021; 107:102641. [PMID: 33129752 DOI: 10.1016/j.otsr.2020.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 01/23/2020] [Accepted: 02/18/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Supra- and intercondylar elbow fractures are surgically challenging given the intra-articular comminution. Various surgical approaches have been described. Among these-olecranon osteotomy-provides optimal joint exposure but is associated with several complications. Tension band wiring (TBW) is the most commonly used fixation method. We hypothesized that double screw fixation would lead to fewer surgical revisions than TBW (all causes included) after olecranon osteotomy. METHODS We carried out a single-center retrospective study of 39 patients, treated between January 2007 and April 2016, for a supra- or intercondylar elbow fracture using the transolecranon exposure. There were 34 type C fractures (13 C1, 6 C2 and 15 C3), 3 type B fractures and 2 type A fractures, based on the AO classification. Fourteen patients received double screw fixation and 25 received TBW. The primary outcome measure was the number of surgical revisions, regardless of cause. Secondary outcome measures were the number of surgical revisions for olecranon nonunion, fixation failure or fixation device removal due to pain. RESULTS There were significantly more surgical revisions in the TBW group than in the double screw fixation group: 3 (21%) versus 14 (56%) (p=0.049, Fisher test). The three main reasons for revision in the TBW and double screw fixation groups were removal of the fixation device due to soft tissue impingement (11 [44%] versus 2 [14%]; p=0.08), failure of the olecranon fixation (6 [24%] versus 1 [7%] p=0.38), and olecranon nonunion (4 [16%] versus 0 [0%] p=0.27). DISCUSSION There are no published studies on the outcomes of this surgical technique. The posterior transolecranon approach provides the best exposure at the elbow joint. TBW fixation is associated with multiple complications. Double screw fixation for olecranon fractures yields good clinical and radiological outcomes. CONCLUSION Based on our findings, double screw fixation of the olecranon results in fewer surgical revisions (all causes combined) than TBW in supra- and intercondylar elbow fractures operated by a transolecranon approach. LEVEL OF EVIDENCE IV.
Collapse
|
21
|
Cañete San Pastor P, Lopez Valenciano J, Copete I, Prosper Ramos I. Fixation of olecranon osteotomy only with 6'5 mm partially trheaded cancellous screw is a safe an effective method used in surgical management of distal humerus fractures. J Exp Orthop 2021; 8:4. [PMID: 33433762 PMCID: PMC7803853 DOI: 10.1186/s40634-020-00317-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/26/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The objective of this study is to demonstrate the safety and efficacy of the osteosynthesis with a 6.5 mm screw and washer of a Chevron shape olecranon osteotomy performed for the surgical approach of supraintercondylar fractures of the distal humerus, achieving union and complication rates better or similar to other published case series. METHODS From 2009 to 2019, 26 patients underwent fixation of an olecranon osteotomy for the treatment of a supraintercondylar fracture of the distal humerus with partially threaded cancellous cannulated screws of 6.5 mm diameter with a washer. The patients were followed for at least 1 year, taking radiographs the day after the surgery, at 3, 6 and 12 months. Complications have been collected: infection, loss of reduction, non-union, delay of union, discomfort of the osteosynthesis hardware. The diameter of the ulna medullary canal diaphysis was also measured in all patients. RESULTS Consolidation of the osteotomy was 100% at 12 months. The average time of radiological consolidation was 112 ± 12 days. The average size of the ulna medullary canal diaphysis was 6'06 ± 0'16 mm on anteroposterior radiographs and 5'65 ± 0'14 mm on lateral radiographs. The mean screw length was 102'31 mm ± 3'89. We found 1 acute infection, 2 osteotomies delays of union (one of these cases was the acute infection case), one early osteosynthesis failure and 1 wound dehiscence. CONCLUSIONS Olecranon ostetomy fixation with a 6'5 mm cancelous partial threaded screw and washer is safe and effective with a high consolidation rate and excellent results and with complication rates similar to or lower than other fixation methods published. Long enough screws must be used to get a good cortical grip with enough stability. LEVEL OF EVIDENCE Level IV, Case series, retrospective review.
Collapse
Affiliation(s)
| | | | - Ivan Copete
- Orthopaedic Surgery Department, Hospital de Manises, Valencia, Spain
| | | |
Collapse
|
22
|
Haglin JM, Lott A, Kugelman DN, Bird M, Konda SR, Tejwani NC, Egol KA. Olecranon Osteotomy Fixation Following Distal Humerus Open Reduction and Internal Fixation: Clinical Results of Plate and Screws Versus Tension Band Wiring. Orthopedics 2021; 44:e107-e113. [PMID: 33089334 DOI: 10.3928/01477447-20201007-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/17/2019] [Indexed: 02/03/2023]
Abstract
Olecranon osteotomy allows for improved visualization of the distal humeral articular surface. This study compared the clinical outcomes of 2 methods of olecranon repair following olecranon osteotomy as part of distal humerus fracture repair. This was a retrospective review of distal humerus fractures treated via a transolecranon approach during a 9-year period. In each case, the olecranon osteotomy was fixed with either tension band wiring (TBW) or plate fixation (PF). Patient demographics, injury information, and surgical management were recorded. Measured outcomes included elbow motion, time to osteotomy union, and postoperative complications. Mayo Elbow Performance Index (MEPI) scores were obtained for all patients. Forty-eight patients were included. All patients had intra-articular AO type 13-C2 or 13-C3 distal humerus fractures and underwent open reduction and internal fixation (ORIF) with olecranon osteotomy. Mean documented follow-up was 20.5 months. Twenty-seven patients had fixation of the olecranon osteotomy with TBW, and 21 with PF. Clinically, there were no differences in osteotomy time to union, elbow motion, or MEPI score at final follow-up. However, patients fixed with TBW had greater elbow extension at both 6-month and final follow-up. Complication rates did not differ. Patients undergoing TBW or PF for repair of an olecranon osteotomy following ORIF of intra-articular distal humerus fractures have similar outcomes. Patients undergoing osteotomy PF may experience less terminal elbow extension when compared with those fixed with TBW. Given their similar clinical outcomes, either modality may be considered when selecting a construct for olecranon osteotomy repair as part of comminuted distal humerus fracture repair. [Orthopedics. 2021;44(1):e107-e113.].
Collapse
|
23
|
Shah NV, Hayes WT, Wang H, Hordines JC, Karakostas JE, Paxinos O, Koehler SM. A pilot biomechanical study comparing a novel, intramedullary Nail/Plate construct to standard Dual-Plate fixation of intra-articular C2.3 distal humerus fractures. Injury 2020; 51:2148-2157. [PMID: 32605784 DOI: 10.1016/j.injury.2020.06.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The gold-standard treatment for intra-articular distal humerus fractures (DHFs) is dual-plate/dual-column fixation, though optimal orientation is not yet established. With a superior method not yet identified, we propose a load-sharing construct, combining absolute stability (extramedullary plate fixation) for distal articular fragments and relative stability (load-sharing intramedullary nail) for the metaphyseal segment. The purpose of this pilot study was to evaluate the biomechanical performance of a novel implant compared to orthogonal dual-plating. MATERIALS AND METHODS Ten fresh-frozen matched-pairs of human cadaveric upper extremities with no prior elbow pathology/surgery were used. Pairs were randomized into two groups: Dual-Plate (medial and posterolateral) or novel Nail/Plate (cross-locked medial nail and posterolateral plate). AO/ASIF type 13-C2.3 multifragmentary fractures with simulated metaphyseal comminution. Biomechanical testing included stiffness (MPa) and load to failure (Newtons) in axial (100 cycles at 3 Hz at 20 N increments from 20 to 100 N) and coronal (varus/valgus; 4,000 cycles from 50N-100 N at 3 Hz) planes. Failed specimens were not analyzed and mechanisms were identified. For all failures, mechanisms were identified and reviewed by three consultant surgeons for revision vs. immobilization, to attempt to recreate a real-world scenario. All outcomes were compared between groups. RESULTS During stiffness testing, zero Nail/Plate specimens failed, but two (20%) Dual-Plate specimens failed (mechanisms: fracture diastasis; bone collapse and intussusception into osteotomy, yielding articular congruency loss). For remaining samples, Nail/Plate (n = 10) coronal (varus/valgus) stiffness was comparable to Dual-Plate (n = 8) constructs (41.5 vs. 39.0 MPa, p = 0.440). Remaining Dual-Plate constructs had greater axial overall stiffness than Nail/Plate (118.3 ± 48.3 vs. 95.6 ± 34.7 MPa, p = 0.020). Failure loads were comparable between Nail/Plate and Dual-Plate constructs (1,327.8 vs. 1,032.4 N, p = 0.170). Individual nail yield strength ranged from 1,101.1-1,124.4 N (n = 2). In review of all failures, the most common overall mechanism was fracture/osteotomy site posterolateral plate bending. Revision recommendation rate was comparable between constructs (Nail/Plate, 22.2% vs. Dual-Plate, 44.4%, p>0.05). CONCLUSIONS The novel Nail/Plate construct demonstrated non-inferior coronal (varus/valgus) stiffness, despite producing lower axial stiffness than orthogonal dual-plating, potentially due to the load-sharing cross-locked design. Considering comparable biomechanical performance, with no failures and comparable recommendations for revision, this novel construct warrants further evaluation as an alternative to the gold-standard, dual-plate fixation method for intra-articular distal humerus fractures. LEVEL OF EVIDENCE N/A.
Collapse
Affiliation(s)
- Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY 11203, USA
| | - Westley T Hayes
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY 11203, USA
| | - Hanbin Wang
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY 11203, USA
| | - John C Hordines
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY 11203, USA
| | - Jonathan E Karakostas
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY 11203, USA
| | - Odysseas Paxinos
- Orthopaedic Department, 251 Hellenic Air Force Hospital, Athens, Greece
| | - Steven M Koehler
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY 11203, USA.
| |
Collapse
|
24
|
T-condylar humerus fracture in children: treatment options and outcomes. INTERNATIONAL ORTHOPAEDICS 2020; 45:1065-1070. [PMID: 32980938 DOI: 10.1007/s00264-020-04827-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
Intracondylar T-type fractures of distal humerus represent a rare condition in paediatric population with unknown incidence since the literature is limited to case reports or case series. The main purpose of this article is to provide a comprehensive review of the current literature about the incidence and diagnostic modalities, as well as to evaluate all treatment options with results and complications. Review of the literature identified nine institutional reports in the period between 1984 and 2015, involving a total of 135 children and adolescents. Treatment options were open reduction with internal fixation and closed reduction in 118 and 17 cases, respectively. Open reduction was performed by different surgical approaches: triceps-sliding, triceps-splitting and olecranon osteotomy. Reported follow-up ranged from ten to 49 months. Outcomes were estimated by various tests, which are mainly based on range of motion. Patients younger than ten years generally had a better range of motion then older patients. Transient neuropathy and elbow stiffness were the most common complications, reported in 16.3% and 9.6% of cases, respectively. Despite the small number of reported clinical series, it is widely accepted that this fracture should be treated by open reduction with internal fixation to reduce and stabilise the displaced intra-articular fragments and to achieve anatomical congruity of the joint and integrity of medial and lateral columns.
Collapse
|
25
|
Surgical Approach and Internal Fixation Techniques for Intra-Articular Distal Humerus Fracture With Coronal Shear Capitellar Fracture. Tech Hand Up Extrem Surg 2020; 25:25-29. [PMID: 32520775 DOI: 10.1097/bth.0000000000000301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Intra-articular distal humerus fractures with an associated coronal shear capitellar fragment present a challenge for stable internal fixation. Adequate visualization and fixation of the capitellar shear fragment are difficult to achieve with conventional exposures, including the olecranon osteotomy. The capitellar fragment often translates anterior and proximally and is challenging to visualize with intact soft tissue attachments from a posterior approach. We describe a surgical exposure that releases the lateral ulnar collateral ligament in addition to an olecranon osteotomy to allow complete visualization of the entire articular surface. In contrast to an isolated capitellar fracture, the column stability and the posterior cortex are frequently disrupted with distal humerus fractures. Depending on the comminution of the posterior cortex, a supplemental posterolateral plate or headless compression screws can provide fixation to the coronal fracture plane. The lateral ulnar collateral ligament is repaired at the conclusion of fracture stabilization through a bone tunnel or to the plate to restore lateral stability. Despite the release of the ligament and additional soft tissue stripping, there were no cases of elbow instability or avascular necrosis in our case series of 9 patients.
Collapse
|
26
|
Ocalan HI, Karakus O, Karakurum G. Comparison of olecranon fixation techniques following transolecranon approach in intra-articular fractures of distal humerus in adult patients. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2020. [DOI: 10.1177/2210491719884944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: In this study, we assessed functional outcomes among olecranon fixation techniques used following transolecranon approach in patients with comminuted fracture of distal humerus. Methods: The study included 37 elbows that underwent olecranon osteotomy due to distal humerus fracture. Functional outcomes were assessed among patients who underwent fixation via tension band technique, plate, or screw fixation. Results: The implant irritation was seen in 18% of patients who underwent K-wire plus tension band fixation, in 75% of patients who underwent olecranon plate plus screw fixation, and in 18% of patients who underwent cancellous screw fixation. The rate for implant removal was 2.6 folds lower in K-wire plus tension band fixation when compared to olecranon plate plus screw fixation. Conclusion: We concluded that K-wire plus tension band technique and cancellous screw fixation performed in accordance with technical principles caused less skin problem when compared to other techniques. In olecranon fixation, both methods with enhanced stability by tension band can be preferred.
Collapse
Affiliation(s)
| | - Ozgun Karakus
- Department of Orthopedic Surgery, Ömer Halisdemir University Hospital, Nigde, Turkey
| | - Gunhan Karakurum
- Department of Orthopedic Surgery, Gaziantep University, Gaziantep, Turkey
| |
Collapse
|
27
|
Baik JS, Lee SH, Kang HT, Song TH, Kim JW. Comparison of open reduction and internal fixation with total elbow arthroplasty for intra-articular distal humeral fractures in older age: a retrospective study. Clin Shoulder Elb 2020; 23:94-99. [PMID: 33330240 PMCID: PMC7714334 DOI: 10.5397/cise.2020.00052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/22/2020] [Accepted: 03/22/2020] [Indexed: 11/25/2022] Open
Abstract
Background Intra-articular distal humeral fractures can be surgically challenging. It remains under discussion whether open reduction and internal fixation (ORIF) or total elbow arthroplasty (TEA) is more beneficial for treatment of the elderly. This study aimed to compare the clinical and functional outcomes of ORIF and TEA for managing intra-articular distal humerus fractures in patients aged 65 years or older. Methods Patients who underwent ORIF (n=28) or TEA (n=43) for in intra-articular distal humerus fracture between May 2008 and December 2018 were reviewed. Range of motion, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, radiologic outcomes, and surgical complications were evaluated at the final follow-up visit. Results The ORIF and TEA groups showed a mean arc of flexion–extension of 97°±21° and 101°±12°, respectively. The mean MEPS and DASH scores were 94±15 and 27±12 points, respectively, in the ORIF group and 81±27 and 47±28 points in the TEA group. This difference was statistically significant. The incidence of total complications was similar between the groups. Conclusions In patients older than 65 years with intra-articular distal humerus fracture, ORIF had better outcomes than TEA.
Collapse
Affiliation(s)
- Jong Seok Baik
- Department of Orthopedic Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Sung Hyun Lee
- Department of Orthopedic Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Hyun Tak Kang
- Department of Orthopedic Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Tae Hyun Song
- Department of Orthopedic Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Jeong Woo Kim
- Department of Orthopedic Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| |
Collapse
|
28
|
Patel SS, Mir HR, Horowitz E, Smith C, Ahmed AS, Downes K, Nydick JA. ORIF of Distal Humerus Fractures with Modern Pre-contoured Implants is Still Associated with a High Rate of Complications. Indian J Orthop 2020; 54:570-579. [PMID: 32850019 PMCID: PMC7429565 DOI: 10.1007/s43465-020-00124-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 04/15/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to identify complications after operative treatment of distal humerus fractures with anatomic, pre-contoured, locking distal humeral plates. We hypothesized that these fractures have high complication rates despite the use of these modern implants. MATERIALS AND METHODS Between 2010 and 2018, 43 adult patients with a distal humerus fracture underwent open reduction and internal fixation (ORIF) at a Level I trauma center. Pre-operative variables, including medical comorbidities, mechanism of injury, open or closed fracture, AO/OTA fracture classification (Type A, B, or C), and nerve palsy, were recorded. Intra-operative variables including surgical approach, ulnar nerve transposition, and plate configuration were recorded. Anatomic, pre-contoured, locking distal humeral plates were used in all patients. Various plating systems were used based on surgeon preference and fracture pattern. Post-operative complications including infection, nonunion, malunion, painful implants, nerve palsy, heterotopic ossification, stiffness, and post-traumatic arthritis were recorded. RESULTS Most fractures were Type C (53%). The posterior olecranon osteotomy approach (51%) and parallel plate configuration (42%) were used in most cases. At a mean follow-up of 15 months, the complication rate was 61% (26/43 patients). Among all patients, 49% (21/43 patients) required a reoperation. Elbow stiffness (19%) was the most common complication followed by nerve palsy (16%). There were four fracture nonunions (9%), deep infections (9%), painful implants (9%), post-traumatic arthritis (9%), and heterotopic ossification (9%). CONCLUSIONS Distal humerus fractures treated with ORIF utilizing anatomic, pre-contoured, locking distal humeral plates have a high complication rate, with many requiring reoperation. LEVEL OF EVIDENCE Therapeutic Level IV.
Collapse
Affiliation(s)
- Shaan S. Patel
- Department of Orthopaedic Surgery, University of South Florida, 5 Tampa General Circle, HMT 710, Tampa, FL 33606 USA
| | - Hassan R. Mir
- Department of Orthopaedic Surgery, University of South Florida, 5 Tampa General Circle, HMT 710, Tampa, FL 33606 USA
- Florida Orthopaedic Institute, 13020 N Telecom Parkway, Tampa, FL 33637 USA
| | - Evan Horowitz
- Department of Orthopaedic Surgery, University of South Florida, 5 Tampa General Circle, HMT 710, Tampa, FL 33606 USA
| | - Carson Smith
- Department of Orthopaedic Surgery, University of South Florida, 5 Tampa General Circle, HMT 710, Tampa, FL 33606 USA
| | - Adil S. Ahmed
- Department of Orthopaedic Surgery, University of South Florida, 5 Tampa General Circle, HMT 710, Tampa, FL 33606 USA
| | - Katheryne Downes
- Florida Orthopaedic Institute, 13020 N Telecom Parkway, Tampa, FL 33637 USA
- Foundation for Orthopaedic Research and Education, 5 Tampa General Circle, HMT 710, Tampa, FL 33606 USA
| | - Jason A. Nydick
- Department of Orthopaedic Surgery, University of South Florida, 5 Tampa General Circle, HMT 710, Tampa, FL 33606 USA
- Florida Orthopaedic Institute, 13020 N Telecom Parkway, Tampa, FL 33637 USA
| |
Collapse
|
29
|
Wei LB, Hu T, Liu J, An ZQ. Surgical Treatment of Intra-Articular Distal Humeral Fractures by using a Combined Medial and Lateral Approach: An Anatomic Study. Orthop Surg 2019; 11:524-529. [PMID: 31207078 PMCID: PMC6595097 DOI: 10.1111/os.12475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/15/2019] [Accepted: 05/13/2019] [Indexed: 11/28/2022] Open
Abstract
Objective To determine the visible size of the distal humeral articular surface by using a novel combined medial‐lateral approach as an alternative method of surgical treatment for intra‐articular distal humeral fractures. Methods In this anatomical study, 12 adult fresh‐frozen cadaveric elbows were randomly divided into a medial‐lateral group and an olecranon osteotomy group, with 6 in each group. In the medial‐lateral group, a medial approach was first used, and then a lateral approach. The sizes of the distal humeral articular surface exposed by each incision and the joined size were measured and calculated. In the olecranon osteotomy group, a posterior olecranon osteotomy approach was applied, and the maximal visible sizes of the articular surface were marked and calculated. Ratios of the maximal sizes of the distal humeral articular surface of the two approaches were compared. Results In the medial‐lateral group, the medial approach could expose 2/5 of the medial trochlea and 1/3 of the capitellum, while the mean visible size of the distal humeral articular surface was 6.8 cm2, 34.8% of the entire surface; the lateral approach can expose 3/7 of the capitellum and 1/4 of the medial trochlea, while the mean visible size of the distal humeral articular surface was 6.7 cm2, 33.9% of the whole surface; for the combined medial‐lateral approach, the mean scope exposed of the medial and lateral visible articular surface was 38.2% and 43.1%, respectively. Meanwhile, in the olecranon osteotomy group, the posterior olecranon osteotomy was found to expose most of the posterior distal humeral articular surface, except for 1/3 of the anterior trochlea and 1/4 of the anterior capitellum, and the visible range of articular surface was 65.3%. The combined medial‐lateral approach exposed 9.2 cm2 in total, 46.9% of the whole distal humeral articular surface, which averaged 19.6 cm2. However, the visible size of the distal humeral articular surface for the olecranon osteotomy approach was 13.7 cm2, 63.1% of the entire distal humeral articular surface, which averaged 21.3 cm2. There was a significant difference observed between the medial‐lateral group (46.9%) and the olecranon osteotomy group (63.1%) for the maximal visible size of the distal humeral articular surface (t = 7.201, P = 0.001). Conclusions The combined medial‐lateral approach can expose 46.9% of the distal humeral articular surface, concentrating on the anterior part, so it can be recommended to treat intra‐articular fractures with a simple pattern in the posterior with the anterior side of the distal humerus less comminuted.
Collapse
Affiliation(s)
- Li-Biao Wei
- Department III of Traumatic Orthopedics Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tu Hu
- Department III of Traumatic Orthopedics Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jie Liu
- Library of Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-Quan An
- Department III of Traumatic Orthopedics Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| |
Collapse
|
30
|
Lee HJ. Surgical Treatment Strategy for Distal Humerus Intra-articular Fractures. Clin Shoulder Elb 2019; 22:113-117. [PMID: 33330205 PMCID: PMC7714297 DOI: 10.5397/cise.2019.22.2.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/01/2019] [Accepted: 04/07/2019] [Indexed: 12/02/2022] Open
Abstract
Treating distal humerus fractures, especially those involving intra-articular lesions, is complex and often technically demanding. Although there still exist many controversial issues, the goal of treatment is to establish anatomical stable fixation by restoring the two columns and the articular surface. Universally, a posterior midline incision is applied, and the approach varies according to the further management of the triceps or olecranon. Evidence supports dual plate fixation as the optimal fixation method, and debates regarding appropriate plating configuration are still ongoing. As multiple clinical studies comparing results of parallel and perpendicular plate fixation have shown no actual difference, it is important to place the plates according to the fracture configuration.
Collapse
Affiliation(s)
- Hyo-Jin Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
31
|
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.
Collapse
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
| |
Collapse
|
32
|
Jupiter J. My journey through the elbow. J Shoulder Elbow Surg 2018; 27:2292-2294. [PMID: 30100178 DOI: 10.1016/j.jse.2017.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/11/2017] [Indexed: 02/01/2023]
Affiliation(s)
- Jesse Jupiter
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
33
|
Yorukoglu AC, Demirkan AF, Buker N. Distal medial tibial locking plate for fixation of extraarticular distal humeral fractures; an alternative choice for fixation. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:294-298. [PMID: 29735339 PMCID: PMC6150447 DOI: 10.1016/j.aott.2018.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 01/17/2018] [Accepted: 02/26/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to describe an alternative fixation method for distal humeral extra-articular fractures through posterior approach using distal tibia anatomic locking plate; and to evaluate the patient's functional outcome and union condition. METHODS Eighteen patients (11 men and 7 women; average age of 37.0 ± 17.3 years (range: 18-73 years)) with a distal humeral extra-articular fracture who were treated with distal tibial medial locking plate were included into the study. The mean follow up time was 36.2 ± 16.7 (12-57) months. Functional results were evaluated with perception of pain, range of joint motion, grasp and pinch strengths. RESULTS Union was achieved in 17 of 18 patients. Only one patient had non-union due to infection and underwent debridement. The mean time for union was 7.8 ± 5.9 months (2-20). Patient perception of pain was X = 1.88 ± 2.50 and X = 4.55 ± 2.68, respectively, at rest and activity. The active ranges of joint motion were adequate for functional use. General functional state of affected extremity (DASH-T) was perfect (X = 27.14 ± 25.66), the performance of elbow joint was good (X = 84.44 ± 11.57). There were no differences in the comparison of grasp and pinch grip of patients with uninvolved extremity (p > 0.05). CONCLUSIONS In distal humeral extra-articular fractures, use of distal medial tibia plate has advantages such as providing high rates for union, low rates for complication, and early return to work with early rehabilitation, therefore it may be considered a fixation choice that can be used for distal humeral extra-articular fractures. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
Affiliation(s)
- Ali Cagdas Yorukoglu
- Pamukkale University, Faculty of Medicine, Department of Orthopedics and Traumatology, Pamukkale, Denizli, Turkey.
| | - Ahmet Fahir Demirkan
- Pamukkale University, Faculty of Medicine, Department of Orthopedics and Traumatology, Pamukkale, Denizli, Turkey.
| | - Nihal Buker
- Pamukkale University, School of Physical Therapy and Rehabilitation, Pamukkale, Denizli, Turkey.
| |
Collapse
|
34
|
Intra-articular fractures of the distal humerus-a review of the current practice. INTERNATIONAL ORTHOPAEDICS 2018; 42:2653-2662. [PMID: 29404666 DOI: 10.1007/s00264-017-3719-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 12/10/2017] [Indexed: 10/18/2022]
Abstract
Intra-articular fractures of the distal humerus are complex injuries that can considerably limit elbow function if not treated appropriately. Surgical management is indicated for most intra-articular distal humerus fractures with the goal of restoring elbow range of motion and function. Open reduction and internal fixation (ORIF) with plates and screws has been the preferred surgical option. Double plating is recommended for bicolumnar fractures and plates can be applied either parallel or orthogonal to each other. Surgical approach for ORIF of the distal humerus can be performed through an olecranon osteotomy, but other approaches that preserve the olecranon are also in use, such as the triceps-reflecting, triceps-splitting, paratricipital, and triceps-reflecting anconeus pedicle approach. The ulnar nerve is identified during the approach, followed by either in situ decompression or anterior transposition. Elbow arthroplasty has also emerged as a viable alternative to ORIF for fixation of these fractures in elderly patients with poor bone quality.
Collapse
|
35
|
A biomechanical comparison of unilateral and bilateral String-of-Pearls™ locking plates in a canine distal humeral metaphyseal gap model. Vet Comp Orthop Traumatol 2017; 27:186-91. [DOI: 10.3415/vcot-13-10-0133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 03/11/2014] [Indexed: 11/17/2022]
Abstract
SummaryObjective: To compare the in vitro biomechanical performance of two String-of-Pearls (SOP) plate constructs in a canine distal humeral metaphyseal gap model.Methods: Seven pairs of canine cadaveric humeri, including the elbow joints, were prepared. One group consisted of a unilateral medially placed SOP plate with bicortical screws (UNI). The second group consisted of bilateral caudo-medial and caudo-lateral SOP plates applied with monocortical screws (BI). A 2 cm ostectomy was performed immediately proximal to the supratrochlear foramen. Constructs were tested in torsion and axial compression.Results: The UNI constructs had significantly lower stiffness in torsion and axial compression than the BI group. However, UNI constructs had a significantly higher ultimate strength than BI constructs. All UNI constructs failed by bending of the transcondylar screw and SOP plate. All BI constructs failed by axial pullout of the distal most screws.Clinical significance: In stabilizing canine supracondylar humeral fractures as modeled here, both the UNI model and the BI model demonstrated biomechanical advantages. The incorporation of a transcondylar screw through the medial plate appears to be beneficial to construct strength.
Collapse
|
36
|
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.
Collapse
Affiliation(s)
- Saif Ul Islam
- Macclesfield District General Hospital, Cheshire, United Kingdom
| | | | - Mohammad Waseem
- Macclesfield District General Hospital, Cheshire, United Kingdom
| |
Collapse
|
37
|
Chen H, Li D, Zhang J, Xiong X. Comparison of treatments in patients with distal humerus intercondylar fracture: a systematic review and meta-analysis. Ann Med 2017; 49:613-625. [PMID: 28537435 DOI: 10.1080/07853890.2017.1335429] [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] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Distal humerus intercondylar fractures are intra-articular comminuted fractures of the elbow that involve soft tissue injury. We evaluate different surgical approaches and elbow functional outcomes in the treatment of distal humerus fracture. MATERIALS AND METHODS Medline, Cochrane, EMBASE, Google Scholar databases were searched up to 29 July 2016. All studies had to have evaluated the treatment of patients with intercondylar fractures of the distal humerus. The primary outcome was the incidence of functional grading of excellent/good. RESULTS The methods used to evaluate elbow function were diverse across the studies and included non-surgical, fixation and plating approaches. The most common surgical technique used was olecranon osteotomy (n = 7) and triceps-sparing (n = 5). In general, most procedures were associated with >70% of patients having excellent/good joint function following surgery. The meta-analysis included four studies with 276 patients, and compared olecranon osteotomy with triceps-sparing. The pooled analysis indicated that patients treated using olecranon osteotomy had better functional outcome than patients treated with triceps-sparing (pooled OR = 2.38, 95%CI: 1.25-4.55, p = .009). CONCLUSIONS This study found that a wide range of surgical procedures were effective in treating most patients with distal humerus intercondylar fractures, and that the approach of olecranon osteotomy may be more effective than that of triceps-sparing in restoring joint function. Key messages Most procedures in treating distal humerus intercondylar fractures were associated with >70% of patients having excellent/good joint function following surgery. The most common surgical technique used in treating distal humerus intercondylar fractures were olecranon osteotomy and triceps-sparing. The pooled analysis indicated that patients treated using olecranon osteotomy had better functional outcome than patients treated with triceps-sparing.
Collapse
Affiliation(s)
- Hongwei Chen
- a Department of Orthopedic Surgery , Yiwu Central Hospital of Wenzhou Medical University , Yiwu , China
| | - Dacheng Li
- b Department of Orthopedic Surgery , Ningbo Mingzhou Hospital , Ningbo , China
| | - Jun Zhang
- b Department of Orthopedic Surgery , Ningbo Mingzhou Hospital , Ningbo , China
| | - Xinwei Xiong
- b Department of Orthopedic Surgery , Ningbo Mingzhou Hospital , Ningbo , China
| |
Collapse
|
38
|
Zumstein MA, Raniga S, Flueckiger R, Campana L, Moor BK. Triceps-sparing extra-articular step-cut olecranon osteotomy for distal humeral fractures: an anatomic study. J Shoulder Elbow Surg 2017; 26:1620-1628. [PMID: 28479258 DOI: 10.1016/j.jse.2017.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/14/2017] [Accepted: 03/01/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND This anatomic study investigated the distal humeral articular surface exposure achievable through a triceps-sparing oblique extra-articular osteotomy of the olecranon with a step-cut modification compared with the anconeus flap transolecranon apex distal chevron osteotomy. In addition, the bone contact surface areas of the osteotomized surfaces after transolecranon and extra-articular osteotomies were compared. METHODS Seven pairs of fresh adult cadaveric elbow joints were examined. Each of the right elbows underwent triceps-sparing extra-articular step-cut olecranon osteotomy (SCOOT) with an anconeus flap, and the left elbows underwent the anconeus flap transolecranon apex distal chevron osteotomies (CO). The articular surface exposed by each of the osteotomy techniques was then digitally analyzed using a 3-dimensional measurement system. The bone contact surface area of the osteotomized surfaces was also assessed. RESULTS The percentage of total joint exposed by the SCOOT group was less than the CO group (SCOOT: 64% ± 3% vs. CO: 73% ± 3%; P = .002). There was significantly greater bone contact surface area of the osteotomized surfaces in the SCOOT group compared with the CO group (SCOOT: 1172 ± 251 mm2 vs. CO: 457 ± 133 mm2; P = .002). CONCLUSION The triceps SCOOT procedure with an anconeus flap provides excellent distal humeral articular surface exposure with the added benefit of a substantially increased (2.6-times) bone contact surface area of the osteotomized surfaces.
Collapse
Affiliation(s)
- Matthias A Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland.
| | - Sumit Raniga
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Remy Flueckiger
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Lorenzo Campana
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Beat K Moor
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland
| |
Collapse
|
39
|
Ao R, Zhang X, Li D, Chen F, Zhou J, Yu B. The Bare Area of the Proximal Ulna: An Anatomic Study With Relevance to Chevron Osteotomy. J Hand Surg Am 2017; 42:471.e1-471.e6. [PMID: 28365147 DOI: 10.1016/j.jhsa.2017.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 02/08/2017] [Accepted: 02/17/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE A chevron osteotomy of the ulna is widely used to obtain intra-articular access to the elbow in the treatment of type C distal humerus fractures. The trochlear notch of the proximal ulna is divided into 2 articular parts by the "bare area." Ideally, the olecranon osteotomy should be centered on the bare area to minimize damage to the joint cartilage. The goals of this study were to describe the anatomy of the bare area and design an ideal chevron-shaped osteotomy. METHODS We dissected 38 cadaver elbows and measured the width of the bare area, the distance between the tip of the triceps insertion and the area on the olecranon cortex corresponding to the bare area. We then designed a chevron osteotomy to stay within the bare area and measured the distance from the tip of the triceps insertion to the osteotomy apex as well as the angle of the osteotomy plane and the angle of the chevron cuts. RESULTS The bare area existed in all 38 cadavers. The mean longitudinal and transverse widths were 4.0 mm (range, 1.0-8.6 mm) and 19.0 mm (range, 16.9-23.8 mm), respectively. The mean distance between the tip of the triceps insertion and the area on the olecranon cortex corresponding to the bare area was 19.0 mm (range, 16.0-23.0 mm). The mean transverse and longitudinal widths of the cortical notch were 3.0 mm (range, 1.6-4.5 mm) and 8.0 mm (range, 6.5-14.8 mm), respectively. The mean distance between the tip of the triceps insertion and the osteotomy apex was 22.0 mm (range, 18.0-24.0 mm) and the mean angle between the osteotomy surface and the vertical plane corresponding to the tangent plane was 20° (range, 10° to 25°). The mean angle of the V shape was 140° (range, 130° to 150°). CONCLUSIONS Using the narrowest edge lacking cartilage (lateral or medial side) as a point of reference to locate the bare area, the designed chevron osteotomy entered the joint in the bare area in most specimens and decreased associated damage to the joint cartilage. CLINICAL RELEVANCE This study describes the anatomy of the bare area and the design of the ideal chevron-shaped osteotomy to treat type C distal humerus fractures.
Collapse
Affiliation(s)
- Rongguang Ao
- Department of Orthopaedics, Shanghai Pudong Hospital, Shanghai Fudan University Pudong Medical Center, Shanghai, China
| | - Xu Zhang
- Department of Orthopaedics, Shanghai Pudong Hospital, Shanghai Fudan University Pudong Medical Center, Shanghai, China
| | - Dejian Li
- Department of Orthopaedics, Shanghai Pudong Hospital, Shanghai Fudan University Pudong Medical Center, Shanghai, China
| | - Fancheng Chen
- Department of Orthopaedics, Shanghai Pudong Hospital, Shanghai Fudan University Pudong Medical Center, Shanghai, China
| | - Jianhua Zhou
- Department of Orthopaedics, Shanghai Pudong Hospital, Shanghai Fudan University Pudong Medical Center, Shanghai, China
| | - Baoqing Yu
- Department of Orthopaedics, Shanghai Pudong Hospital, Shanghai Fudan University Pudong Medical Center, Shanghai, China.
| |
Collapse
|
40
|
Iwamoto T, Suzuki T, Matsumura N, Nakamura M, Matsumoto M, Sato K. Lateral Para-Olecranon Approach for the Treatment of Distal Humeral Fracture. J Hand Surg Am 2017; 42:344-350. [PMID: 28359639 DOI: 10.1016/j.jhsa.2017.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 02/13/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the outcomes of the lateral para-olecranon triceps-splitting approach for the treatment of distal humeral fracture. METHODS Ten patients (3 males, 7 females) with a mean age of 59 years were retrospectively reviewed. There were 2 A2, 3 C1, and 5 C2 fractures according to the AO/ASIF classification. Types B3 and C3 fractures were excluded from this study because the olecranon osteotomy approach was indicated to visualize the anterior fragment. The triceps was split at the midline, and the anconeus muscle was incised from the proximal ulna. The lateral half of the triceps along with anconeus was retracted laterally as a single unit. The distal part of the humerus could be visualized from medial and lateral windows by retracting the medial half of the triceps. The articular fragment was anatomically reduced and fixed temporarily with a Kirschner wire, and the reconstructed distal articular block was then fixed to the humeral shaft with double locking plates. RESULTS After surgery, average elbow flexion was 127° (range, 110°-145°), and extension was -10° (range, -20°-0°) at the average follow-up time of 12.4 months (range, 8‒20 months). Seven patients had normal muscle strength against full resistance (manual muscle testing grade 5), and the other 3 patients had slightly reduced muscle strength (grade 4). No articular stepoffs of more than 1 mm were seen on postoperative radiographs. There were no cases of triceps insufficiency and nonunion. The average (± SD) Mayo Elbow Score was 93.5 ± 5.8 points at the final follow-up. CONCLUSIONS The lateral para-olecranon approach is useful for the management of selected fractures of the distal humerus, preserving extension strength and providing satisfactory clinical outcomes, with no risk of olecranon osteotomy-related complications. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
Collapse
Affiliation(s)
- Takuji Iwamoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Taku Suzuki
- Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazuki Sato
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
41
|
Kural C, Ercin E, Erkilinc M, Karaali E, Bilgili MG, Altun S. Bicolumnar 90-90 plating of AO 13C type fractures. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:128-132. [PMID: 28341102 PMCID: PMC6197599 DOI: 10.1016/j.aott.2016.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/11/2016] [Accepted: 09/23/2016] [Indexed: 11/18/2022]
Abstract
Objective The aim of this study was to evaluate functional results and complication rate of patients who underwent medial-dorsolateral plating for intra-articular distal humeral fracture (Müller AO type 13C). Methods Twenty-four patients (14 men, 10 women; mean age: 47 years) with AO type 13C distal humerus fracture were included in the study. Mean follow-up time was 28 months. Nine patients were in 13C1 subgroup, according to AO classification system, 11 patients were categorized as 13C2, and 4 patients were 13C3. Final follow-up assessment of outcomes included Broberg and Morrey radiological criteria; Mayo Elbow Performance Score, disabilities of the Arm, Shoulder and Hand (DASH) Outcome Measure, score based on Jupiter criteria; and range of motion (ROM) values. Results The mean carrying angle of operated elbows was 11.37° (range: 0-20°). According to Broberg and Morrey radiological criteria, 14 patients, had radiologically normal elbow, 4 patients had mild change, 3 patients had moderate change, and 3 patients had severe radiological change. Mean DASH score was 21.91 (range: 0-50), and mean Mayo rating was 83.37 (range: 55-100). Jupiter criteria evaluation revealed excellent results in 10 cases, good in 12, and fair results in 2. One patient with fair result had open fracture, and the other had previous hemiparesis in the same extremity. There was no instance of nonunion observed at follow-up. Conclusion Osteosynthesis with medial-dorsolateral plating is a safe and effective method for the treatment of intra-articular fractures of distal humerus. Level of evidence Level IV, Therapeutic study.
Collapse
|
42
|
Atalar AC, Tunalı O, Erşen A, Kapıcıoğlu M, Sağlam Y, Demirhan MS. Biomechanical comparison of orthogonal versus parallel double plating systems in intraarticular distal humerus fractures. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:23-28. [PMID: 27965047 PMCID: PMC6197297 DOI: 10.1016/j.aott.2016.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/09/2016] [Accepted: 11/07/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In intraarticular distal humerus fractures, internal fixation with double plates is the gold standard treatment. However the optimal plate configuration is not clear in the literature. The aim of this study was to compare the biomechanical stability of the parallel and the orthogonal anatomical locking plating systems in intraarticular distal humerus fractures in artificial humerus models. METHODS Intraarticular distal humerus fracture (AO13-C2) with 5 mm metaphyseal defect was created in sixteen artificial humeral models. Models were fixed with either orthogonal or parallel plating systems with locking screws (Acumed elbow plating systems). Both systems were tested for their stiffness with loads in axial compression, varus, valgus, anterior and posterior bending. Then plastic deformation after cyclic loading in posterior bending and load to failure in posterior bending were tested. The failure mechanisms of all the samples were observed. RESULTS Stiffness values in every direction were not significantly different among the orthogonal and the parallel plating groups. There was no statistical difference between the two groups in plastic deformation values (0.31 mm-0.29 mm) and load to failure tests in posterior bending (372.4 N-379.7 N). In the orthogonal plating system most of the failures occurred due to the proximal shaft fracture, whereas in the parallel plating system failure occurred due to the shift of the most distal screw in proximal fragment. CONCLUSION Our study showed that both plating systems had similar biomechanical stabilities when anatomic plates with distal locking screws were used in intraarticular distal humerus fractures in artificial humerus models.
Collapse
Affiliation(s)
- Ata C Atalar
- Istanbul University, Istanbul Medical Faculty Orthopaedics and Traumatology Department, Istanbul, Turkey.
| | - Onur Tunalı
- Istanbul University, Istanbul Medical Faculty Orthopaedics and Traumatology Department, Istanbul, Turkey.
| | - Ali Erşen
- Istanbul University, Istanbul Medical Faculty Orthopaedics and Traumatology Department, Istanbul, Turkey.
| | - Mehmet Kapıcıoğlu
- Istanbul University, Istanbul Medical Faculty Orthopaedics and Traumatology Department, Istanbul, Turkey.
| | - Yavuz Sağlam
- Istanbul University, Istanbul Medical Faculty Orthopaedics and Traumatology Department, Istanbul, Turkey.
| | - Mehmet S Demirhan
- Koç University, Medical Faculty Orthopaedics and Traumatology Department, Istanbul, Turkey.
| |
Collapse
|
43
|
Patel J, Motwani G, Shah H, Daveshwar R. Outcome after internal fixation of intraarticular distal humerus (AO type B & C) fractures: Preliminary results with anatomical distal humerus LCP system. J Clin Orthop Trauma 2017; 8:63-67. [PMID: 28360500 PMCID: PMC5359525 DOI: 10.1016/j.jcot.2017.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/13/2016] [Accepted: 02/09/2017] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The treatment of intraarticular fractures of the distal humerus is challenging and involves the risk of complications and bad functional results. Anatomical and stable internal fixation with early postoperative mobilization is expected to improve the functional outcomes. The objective of this study was to evaluate the functional and radiological results, along with the complications associated, of open reduction and internal fixation using precontoured anatomical locking LCP plate system for intraarticular distal humerus fractures in adult patients. METHODS This prospective study consist of 31 patients with a mean age of 41.2 years (range 19-62) were treated with open reduction and angular stable internal fixation. All underwent posterior transolecranon surgical approach. Mean follow-up to the final interview was 10 months (from 6 to 20 months). All operated patients were available at the time of last followup. AO classification showed 26 C-fractures (9*13C 1, 12*13C2,5* 13C3) and 5 B-fracture (1* 13B1,1* 13B2,3* 13B3). There were 25 closed fractures and 6 open grade 1 fractures. The clinical followup using Mayo elbow performance score (MEPS) and radiographic follow up with elbow anterior-posterior and lateral view X-rays were performed postoperatively. RESULTS The mean MEPS was 87.9 points out of 100 (range 55-100) with 61% Excellent, 29% good and 10% fair and poor scores. Mean elbow flexion of 115.8° (range 85°-150°). The mean deficit in extension was 19° (range 5°-35°). All olecranon osteotomy were united .Nonunion of distal humerus fracture occurred in 2 cases. Other complications were hardware prominence in 3 cases, superficial infection in 4 cases and Ulnar nerve neuropraxia in 1 case which was recovered uneventfully. Revision surgery was not required in any complication. CONCLUSION Open reduction and internal fixation with precontoured distal humerus anatomical locking plate system is a good method of treatment for complex Supra- intercondylar fracture of distal humerus with good functional outcome and low rates of complications. Even though early results are promising, longer term investigations and larger patient groups are necessary to confirm the presented data.
Collapse
Affiliation(s)
- Jwalant Patel
- Department of Orthopaedics, Medical College, Baroda, India
| | - Girish Motwani
- Department of Orthopaedics, Medical College, Baroda, India,Department of Paediatric Orthopaedics, B.J. Wadia Hospital for Childrens, Mumbai, India,Fellow in Orthopaedics, University of Alabama, Birmimgham, USA,Corresponding author at: Fellow in Orthopaedics, University of Alabama, Birmimgham, USA.
| | - Himanshu Shah
- Department of Orthopaedics, Medical College, Baroda, India
| | | |
Collapse
|
44
|
Svernlöv B, Nestorson J, Adolfsson L. Subjective ulnar nerve dysfunction commonly following open reduction, internal fixation (ORIF) of distal humeral fractures and in situ decompression of the ulnar nerve. Strategies Trauma Limb Reconstr 2016; 12:19-25. [PMID: 27909969 PMCID: PMC5360670 DOI: 10.1007/s11751-016-0271-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/19/2016] [Indexed: 11/26/2022] Open
Abstract
The aim of this retrospective study was to investigate the frequency of persistent ulnar affection in patients who underwent open reduction and internal fixation (ORIF) of distal humeral fractures without ulnar nerve transposition or mobilisation. Eighty-two patients (53 women), mean age 62 years, were, at a mean of 48 months, reviewed through medical records and a subjective evaluation form concerning ulnar nerve problems. Ulnar nerve affliction, in most cases regarded as mild, was experienced by 22 patients (27%; 14 women) and significantly associated with multiple surgeries. Three patients had been operated with late neurolysis and one with transposition without reported improvement. The proportion of ulnar nerve dysfunction was equally common regardless of medial or lateral plating. ORIF with plate fixation and without ulnar nerve transposition seems to be an acceptable option for patients with distal humeral fractures. The frequency of ulnar nerve affection in our series does not appear higher than previously reported. Subjective ulnar nerve symptoms were, however, relatively common and appear related to the trauma itself, the surgery, or the post-operative management which highlights the need for further analysis of these factors.
Collapse
Affiliation(s)
- Birgitta Svernlöv
- Department of Plastic Surgery, Hand Surgery and Burns, Linköping University Hospital, 581 85, Linköping, Sweden.
- Faculty of Experimental and Clinical Medicine, Linköping University, Linköping, Sweden.
| | - Jens Nestorson
- Department of Orthopedic Surgery, Linköping University Hospital, 581 85, Linköping, Sweden
- Faculty of Health Science, Linköping University, Linköping, Sweden
| | - Lars Adolfsson
- Department of Orthopedic Surgery, Linköping University Hospital, 581 85, Linköping, Sweden
- Faculty of Health Science, Linköping University, Linköping, Sweden
| |
Collapse
|
45
|
Claessen FMAP, Stoop N, Doornberg JN, Guitton TG, van den Bekerom MPJ, Ring D, Chauhan A, Wahegaonkar A, Shafritz A, Garcia G A, Miller A, Barquet A, Kristan A, Apard T, Armstrong A, Berner A, Jubel A, Kreis B, Babis C, Sutker B, Sears B, Nolan B, Crist B, Cross B, Wills B, Barreto C, Ekholm C, Swigart C, Oliveira Miranda C, Manke C, Zalavras C, Goldfarb C, Cassidy C, Walsh C, Jones C, Garnavos C, Young C, Moreno-Serrano C, Lomita C, Klostermann C, van Deurzen D, Rikli D, Polatsch D, Beingessner D, Drosdowech D, Eygendaal D, Patel M, Brilej D, Walbeehm E, Ballas E, Ibrahim E, Melamed E, Stojkovska Pemovska E, Hofmeister E, Hammerberg E, Kaplan F, Suarez F, Fernandes C, Lopez-Gonzalez F, Walter F, Frihagen F, Kraan G, Kontakis G, Dyer G, Kohut G, Panagopoulos G, Hernandez G, Porcellini G, Bayne G, Merrell G, DeSilva G, Della Rocca G, Bamberger H, Broekhuyse H, Durchholz H, Kodde I, McGraw I, Harris I, Pountos I, Wiater J, Choueka J, Kazanjian J, Gillespie J, Biert J, Fanuele J, Johnson J, Greenberg J, Abrams J, Hall J, Fischer J, Scheer J, Itamura J, Capo J, Braman J, Rubio J, Ortiz J, Filho J, Nolla J, Abboud J, Conflitti J, Abzug J, Patiño J, Rodríguez Roiz J, Adams J, Bishop J, Kabir K, Chivers K, Prommersberger K, Egol K, Rumball K, Dickson K, Jeray K, Poelhekke L, Campinhos L, Mica L, Borris L, Adolfsson L, Schulte L, Elmans L, Lane L, Paz L, Taitsman L, Guenter L, Austin L, Waseem M, Palmer M, Abdel-Ghany M, Richard M, Rizzo M, Pirpiris M, Di Micoli M, Bonczar M, Loebenberg M, Richardson M, Mormino M, Menon M, Soong M, Wood M, Meylaerts S, Darowish M, Nancollas M, Prayson M, Grafe M, Kessler M, Kaminaris M, Pirela-Cruz M, Mckee M, Merchant M, Tyllianakis M, Shafi M, Powell A, Shortt N, Felipe N, Parnes N, Bijlani N, Elias N, Akabudike N, Rossiter N, Lasanianos N, Kanakaris N, Brink O, van Eerten P, Paladini P, Martineau P, Appleton P, Levin P, Althausen P, Evans P, Jebson P, Krause P, Schandelmaier P, Peters A, Dantuluri P, Blazar P, Andreas P, Inna P, Quell M, Ramli R, de Bedout R, Ranade A, Ashish S, Smith R, Babst R, Omid R, Buckley R, Jenkinson R, Gilbert R, Page R, Papandrea R, Zura R, Gray R, Wagenmakers R, Pesantez R, van Riet R, Calfee R, van Helden S, Bouaicha S, Kakar S, Kaplan S, Scott F, Kaar S, Mitchell S, Rowinski S, Dodds S, Kennedy S, Beldner S, Schepers T, Guitton T, Gosens T, Baxamusa T, Taleb C, Tosounidis T, Wyrick T, Begue T, DeCoster T, Dienstknecht T, Varecka T, Mittlmeier T, Fischer T, Chesser T, Omara T, Bafus T, Siff T, Havlicek T, Sabesan V, Nikolaou V, Philippe V, Giordano V, Vochteloo A, Batson W, Hammert W, Satora W, Weil Y, Ruch D, Marsh L, Swiontkowski M, Hurwit S. Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation. J Hand Surg Am 2016; 41:e337-e341. [PMID: 27522299 DOI: 10.1016/j.jhsa.2016.07.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/17/2016] [Accepted: 07/13/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth. METHODS A total of 232 orthopedic residents and surgeons from around the world evaluated 24 anteroposterior and lateral radiographs of distal humerus fractures on a Web-based platform to predict which implants would loosen or break. Agreement among observers was measured using the multi-rater kappa measure. RESULTS The sensitivity of prediction of failure of fixation of distal humerus fracture on radiographs was 63%, specificity was 53%, positive predictive value was 36%, the negative predictive value was 78%, and accuracy was 56%. There was fair interobserver agreement (κ = 0.27) regarding predictions of failure of fixation of distal humerus fracture on radiographs. Interobserver variability did not change when assessed for the various subgroups. CONCLUSIONS When experienced and skilled surgeons perform fixation of type C distal humerus fracture, the immediate postoperative radiograph is not predictive of fixation failure. Reoperation based on the probability of failure might not be advisable. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
Collapse
Affiliation(s)
- Femke M A P Claessen
- Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Nicky Stoop
- Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Job N Doornberg
- Orthotrauma Research Center Amsterdam, University of Amsterdam Orthopaedic Residency Program, Amsterdam, The Netherlands
| | - Thierry G Guitton
- Orthotrauma Research Center Amsterdam, University of Amsterdam Orthopaedic Residency Program, Amsterdam, The Netherlands
| | | | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
Fractures of the distal humerus in the adult comprise approximately one third of all humeral fractures. Successful management of distal humerus fractures depends on correct reduction of the fracture, reconstruction of the articular surface if needed, stability and rigidity of the fixation, and appropriate rehabilitation. In this review, we evaluated the available literature and highlighted current therapy concepts. We assessed the evolution of internal fixation and elbow arthroplasty focusing on the established surgical approaches against the background of a growing incidence of distal humeral fractures in an aging patient population. Therefore evaluating the aspect and influence of age-dependent comorbidities like osteoporosis on successful treatment.
Collapse
Affiliation(s)
- Steinitz Amir
- Department of Traumatology and Orthopedic Surgery, University Hospital Basel, Spitalstr. 21, 4031 Basel, Switzerland
| | - Sailer Jannis
- Department of Traumatology and Orthopedic Surgery, University Hospital Basel, Spitalstr. 21, 4031 Basel, Switzerland
| | - Rikli Daniel
- Department of Traumatology and Orthopedic Surgery, University Hospital Basel, Spitalstr. 21, 4031 Basel, Switzerland
| |
Collapse
|
47
|
Meislin MA, Wagner ER, Shin AY. A Comparison of Elbow Range of Motion Measurements: Smartphone-Based Digital Photography Versus Goniometric Measurements. J Hand Surg Am 2016; 41:510-515.e1. [PMID: 26880499 DOI: 10.1016/j.jhsa.2016.01.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 01/04/2016] [Accepted: 01/08/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to validate elbow flexion and extension measured from smartphone photography obtained by participants and compared them with photographs obtained by surgeons and goniometric measurements. METHODS We enrolled 32 participants with a total of 64 elbows, aged 25 to 68 years. Participants obtained smartphone photographs of full elbow flexion and extension. Then surgeons obtained the same photographs and goniometric measurement of elbow range of motion (ROM). We measured ROM from the photographs using Adobe Photoshop and calculated average ROM. Comparisons of manual goniometer versus digital measurements, participant versus surgeon photograph measurements, and interobserver measurements were statistically analyzed. RESULTS Average ROM measured by manual goniometer and digital photographs was 0° to 129° (range, 0° to 140°) and 0° to 129° (range, 0° to 145°), respectively. The goniometer versus digital measurements interclass correlation was 0.828 (L) and 0.740 (R). Pearson coefficient was 0.845 (L) and 0.757 (R). Bland-Altman plots demonstrated that 30 of 32 digital measurements (L) and 31 of 32 measurements (R) were within the 95% confidence interval. Participant-obtained photographs compared with researcher's photographs interclass correlation was 0.955 (L) and 0.941 (R), with a Pearson coefficient of 0.962 (L) and 0.957 (R), respectively. Reviewing interobserver reliability, concordance coefficients were 0.793 (L) and 0.767 (R) and Pearson coefficients were 0.811 (L) and 0.780 (R). Bland-Altman plots demonstrated that 28 of 32 digital measurements (L) and 26 of 32 measurements (R) were within the 95% confidence interval. CONCLUSIONS Measuring elbow ROM using smartphone digital photography is valid and reliable. Participants were able to obtain accurate photographs and the measurements based on these photographs show no statistical difference from those taken by surgeons or goniometric measurement. CLINICAL RELEVANCE This study validates using smartphone photography for measuring elbow ROM by laymen in a remote setting. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
Collapse
Affiliation(s)
- Megan A Meislin
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN
| | - Eric R Wagner
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
| |
Collapse
|
48
|
Spagnolo R, Caroli F, Capitani P, Sala F. Simultaneous bilateral "floating arm" of the humeri: an uncommon presentation of a rare complex injury and review of the literature. Injury 2015; 46 Suppl 7:S17-9. [PMID: 26738453 DOI: 10.1016/s0020-1383(15)30038-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The timing of definitive fixation for simultaneous fractures of the humerus in polytrauma patient is controversial. We report on the management of a patient that sustained bilateral "floating arm" fractures of the humeri. When dealing with such injury patterns, it is important to always carry out stabilization of the humeral diaphysis first and afterwards to treat the sub-injury or over-injury fractures. Our patient healed after twelve weeks in both humeri. After seven years MEPS showed excellent and good results in the right and left arms, while UCLA scores proved excellent in both sides. We encountered no intraoperative and postoperative complications.
Collapse
Affiliation(s)
- Rosario Spagnolo
- Department of Orthopaedic Surgery and Traumatology, Romano di Lombardia Hospital, Bergamo, Italy
| | - Fabrizio Caroli
- Department of Orthopaedic Surgery and Traumatology, Romano di Lombardia Hospital, Bergamo, Italy
| | - Paolo Capitani
- Department of Orthopedic Surgery and Traumatology, Niguarda Hospital, Milan, Italy
| | - Francesco Sala
- Department of Orthopedic Surgery and Traumatology, Niguarda Hospital, Milan, Italy.
| |
Collapse
|
49
|
Zumstein MA, Bürki A, Massy AS, Zysset P, Moor BK. Extra-articular step osteotomy of the olecranon: A biomechanical assessment. Clin Biomech (Bristol, Avon) 2015; 30:1043-8. [PMID: 26443882 DOI: 10.1016/j.clinbiomech.2015.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/09/2015] [Accepted: 09/09/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Trans-olecranon chevron osteotomies (COs) remain the gold standard surgical approach to type C fractures of the distal humerus. This technique is associated with a high complication rate and development of an extra-articular olecranon osteotomy may be advantageous. The aim of this study was to compare the load to failure of COs with extra-articular oblique osteotomies (OOs) as well as modified, extra-articular step osteotomies (SOs). METHODS These three osteotomies and their subsequent fixation utilizing a standardized tension band wiring technique were tested in 42 composite analog ulnae models at 20° and 70° of flexion. Triceps loading was simulated with a servo hydraulic testing machine. All specimens were isometrically loaded until failure. Kinematic and force data, as well as interfragmentary motion were recorded. RESULTS At 70°, CO failed at a mean load of 963 N (SD 104 N), the OO at 1512 N (SD 208 N) and the SO at 1484 N (SD 153 N), (P<0.001). At 20°, CO failed at a mean load of 707 N (SD 104 N) and OO at 1009 N (SD 85 N) (P=0.006). The highest load to failure was observed for the SO, which was 1277 N (SD 172 N). The load to failure of the SO was significantly higher than the CO as well as the OO. CONCLUSION Extra-articular osteotomies showed a significantly higher load to failure in comparison to traditional CO. At near full extension (20° of flexion), this biomechanical advantage was further enhanced by a step-cut modification of the extra-articular oblique osteotomy.
Collapse
Affiliation(s)
- Matthias A Zumstein
- Department of Orthopaedic Surgery and Traumatology, University of Bern, Insel Hospital, Switzerland.
| | - Alexander Bürki
- Institute for Surgical Technology and Biomechanics, University of Berne, Stauffacherstrasse 78, Bern, Switzerland
| | - Anne-Sophie Massy
- Department of Orthopaedic Surgery and Traumatology, University of Bern, Insel Hospital, Switzerland
| | - Philippe Zysset
- Institute for Surgical Technology and Biomechanics, University of Berne, Stauffacherstrasse 78, Bern, Switzerland
| | - Beat K Moor
- Department of Orthopaedic Surgery and Traumatology, University of Bern, Insel Hospital, Switzerland
| |
Collapse
|
50
|
Pogliacomi F, Aliani D, Cavaciocchi M, Corradi M, Ceccarelli F, Rotini R. Total elbow arthroplasty in distal humeral nonunion: clinical and radiographic evaluation after a minimum follow-up of three years. J Shoulder Elbow Surg 2015; 24:1998-2007. [PMID: 26475638 DOI: 10.1016/j.jse.2015.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/07/2015] [Accepted: 08/09/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total elbow arthroplasties (TEAs) are usually indicated in chronic inflammatory arthropathies. This procedure has also recently been used in complex distal humeral fractures and nonunions in selected patients. This study analyzed the clinical and radiographic outcomes in patients treated for nonunions around the elbow region with a minimum follow-up of 3 years. METHODS Between May 2002 and June 2012, 20 patients affected with distal humeral nonunions were treated with TEA. All patients were assessed clinically using the Mayo Elbow Performance Score and radiographically to evaluate the positioning of the prosthetic components and signs of loosening. Statistical analyses were performed to investigate the presence of clinical and radiographic variables as predictive factors of poor functional outcomes. RESULTS The Mayo Elbow Performance Score of the affected arm improved significantly between the preoperative period and follow-up. Results were good or excellent in 90% of the patients even if a high rate of complications (30%) was encountered. The development of complications after surgery and stages II, III, and IV radiolucency, according to the Morrey criteria, were predictive factors of poor outcomes. CONCLUSIONS According to the satisfactory results observed in this study, TEA could be indicated in selected patients aged older than 70 years with low functional demands and affected with distal humeral nonunions in which obtaining a stable fixation is difficult.
Collapse
Affiliation(s)
| | - Davide Aliani
- Orthopaedic and Traumatologic Department, University of Parma, Parma, Italy.
| | | | - Maurizio Corradi
- Orthopaedic and Traumatologic Department, University of Parma, Parma, Italy
| | | | - Roberto Rotini
- Shoulder and Elbow Unit, Rizzoli Orthopedic Institute, Bologna, Italy
| |
Collapse
|