Clinical effects of mini-locking plate with vertical or parallel technology for treatment of Dubberley type B capitellar fractures

Abstract

Objective To investigate the clinical effects of mini-locking plate with vertical or parallel technology in the treatment of Dubberley type B capitellar fractures. Methods A case series study was done on clinical data of 17 cases of Dubberley type B capitellar fractures treated through operation with vertical or parallel mini-locking plate. There were 12 males and 5 females, with age range of 23-77 years (mean 56.4 years). The fractures were classified according to the Dubberley system, including type ⅠB in 2 cases, ⅡB in 6 and type ⅢB in 9. The operations were conducted through the Kocher approach at posterior-lateral rear elbow joint and the fractured bone was fixed firstly with Kirschner wire and mini screws after resetting and then with vertical or parallel mini locking plate. The surgery time and bleeding volume during the surgery were recorded. The position of fracture, healing, avascular necrosis of capitellum, heterotopic ossification, and traumatic arthritis were evaluated. At the final follow-up, the Mayo elbow performance score (MEPS) was used to evaluate the function of elbow, and flexion and extension of the elbow, swing of the forearm and inner stability of the elbow joint were evaluated. Results The surgery time was 50-90 minutes (mean 60 minutes). The bleeding volume during surgery was 40-120 ml (mean 60 ml). All patients were followed up for 12-24 months (mean 12.1 months). Anatomical reduction was seen in 12 cases and almost anatomical reduction in 5. None had vessel or nerve wound, and the wound was healed at phase Ⅰ within 10-12 days after operation. The clinical fracture healing time was 8-12 weeks (mean 11.4 weeks). At the final follow-up, the fractures were well healed without complications like fracture reduction loss, ischemic necrosis of the humerus, traumatic arthritis or heterotopic ossification of the elbow joint. MEPS in all cases was 60-100 points (mean 87.6 points). MEPS assessment result was excellent in 13 cases, good in 3 and fair in 1, with the excellent rate of 94%. At the final follow-up, the average activity of the elbow was 6 ° (0°-10°) for extension and 118° (90°-130°) for flexion, the average forearm pronation was 70° (60°-90°), the average forearm supination was 82°(70°-90°), and the inner stress test showed no instability. Conclusion Vertical or parallel mini-locking plate in the treatment of Dubberley type B capitellar fractures is associated with few complications, early functional exercise after operation, and satisfactory short-term outcome. Key words: Humeral fractures; Fracture fixation, internal; Mini-locking plate