Abstract
Purpose: To study the functional and radiological outcomes of AO type C distal humerus fractures (DHFs) in adults treated surgically with bicolumnar fixation.
 Methods: A prospective study of 30 adult patients with AO/OTA type C fractures of the distal humerus treated operatively with bicolumnar fixation between September 2018 to December 2020 at Sree Balaji Medical College & Hospital, Chennai was performed. Closed distal humerus fractures with intra-articular extension were fixed with bicolumnar plating, with orthogonal or parallel configuration of plate fixation decided intra-operatively. This was achieved in all patients after performing an olecranon osteotomy for better exposure of the fracture site, which was later fixed with either CC screws or K-wires with tension band wiring. The functional and radiological outcomes in this study group were assessed on regular post-operative follow-up. The Mayo Elbow Performance Score (MEPS) was used to evaluate the functional outcomes in our patients.
 Results: The mean age of the patients was 44 years, with 18 (60%) males and 12 (40%) females in the study. The right-sided elbow was more frequently involved (57%) in our study. The most common mode of injury was Motor Vehicle Accident (MVA) (14 cases; 47%), while domestic fall contributed to 10 (33%) cases. Fall from height and direct trauma to the elbow made up the rest of the cases, with a 10% incidence each. A majority of cases (22 cases; 73%) showed radiological union between 12-16 weeks post-operatively, whereas 8 cases (27%) united between 17-21 weeks. The Mayo Elbow Performance Score (MEPS) used to assess the functional outcome showed excellent results in 25 (83%) cases, good and fair results in 2 (7%) cases each, and a poor outcome in 1 (3%) case.
 Conclusion: For satisfactory results in intraarticular fractures of the distal humerus treated with bicolumnar plating, thorough pre-operative planning, posterior surgical approach with adequate exposure via olecranon osteotomy, anatomical inter-fragmentary stabilization by dual plating, and early post-operative mobilization with physiotherapy are important steps to be followed.
Highlights
Distal humerus fractures (DHFs) in adults comprise 2% of all fractures, & roughly 1/3rd of all humeral fractures, with an incidence of 5.7/100000 per year [1]
Most DHFs in young adults are a result of high-energy trauma sustained during road traffic accidents (RTAs), sports injuries, sideswipe injuries, gunshot wounds, & falls from height, while elderly persons usually have a history of low-energy trauma sustained via simple falls with direct impact on the elbow [4,5] or indirect impact because of a fall on the outstretched hand
Out of 30 patients who participated in our study, majority of them (14 cases) sustained DHF because of Motor Vehicle Accident (MVA)
Summary
Distal humerus fractures (DHFs) in adults comprise 2% of all fractures, & roughly 1/3rd of all humeral fractures, with an incidence of 5.7/100000 per year [1]. Most DHFs in young adults are a result of high-energy trauma sustained during road traffic accidents (RTAs), sports injuries, sideswipe injuries, gunshot wounds, & falls from height, while elderly persons usually have a history of low-energy trauma sustained via simple falls with direct impact on the elbow [4,5] or indirect impact because of a fall on the outstretched hand. Various challenges like articular surface fragmentation in multiple planes, separation of articular fragments from distal humeral columns, and deficient bone quality are faced by surgeons intra-operatively. Complications like malunion and non-union are common, with even slight irregularities of articular surfaces of the elbow causing loss of function, and secondary arthritis
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