Distal humerus extraarticular fractures with large butterfly fragment: How we deal with it

Abstract

Background: The treatment of distal-third extra-articular fracture of the humerus with large butterfly fragment is challenging and often controversial. The aim of this study is to see the result of open reduction and internal fixation of such fractures fixed with pre-contoured extra-articular anatomical locking plate in context to percentage of union, time of union and functional capability. Materials and Methods: This is a prospective study comprising of 28 cases from 2016 to 2019 with average follow-up of 19 months. In this study, all the cases included were extra-articular fractures of distal humerus having large butterfly fragments and were comminuted. The simple distal humeral extra-articular fractures without comminution were excluded from study. All the patients were operated on with posterior triceps reflecting approach and fixing the fractures with 3.5 mm pre-contoured extra-articular locking plate. Results: Out of 28 cases, there were 17 males and 11 females with mean age of 34.8 years. 4 patients were having post injury radial nerve palsy. None of the patients in our series were treated conservatively. The average time of operation after injury was 7 days and the average time of union was 20 weeks. 3 of the patients post operatively developed radial nerve palsy which completely recovered within 5 months. The results were evaluated with Mayo elbow performance score. Conclusion: Distal humeral comminuted extra-articular fractures are complex and difficult to manage. A pre-contoured distal humeral plate is a good option and gives adequate purchase for distal fixation. Moreover, the triceps sparing approach is good and chances of nerve injury and stiffness are less. We are happy with this plate and type of fixation.