Fixation of extra-articular distal humeral fractures with a lateral approach and a locked plate: an alternative method.

Abstract

The purpose of this study was to evaluate the efficacy of lateral approach and anterolateral anatomical locked plate fixation on clinical and radiological healing of extra-articular distal humeral fractures. Twenty-three (17 male, 6 female) consecutive patients who underwent surgical management for closed extra-articular comminuted distal humeral fractures between 2006 and 2013 were included in this study. Anterolateral fixation with an anatomical locked plate using a lateral approach was preferred. Mean age was 34 years (range: 17-56 years). AO Foundation/American Orthopaedic Trauma Association (AO/OTA) classification was used; all patients had AO/OTA 12-B1.3 type fractures. Inclusion criteria were patients with polytrauma, late-onset radial nerve injury, and unsatisfactory closed reduction. Patients were followed up at postoperative weeks 6, 12, and 24, and in 3-month intervals thereafter. Mean follow-up period was 16 months (range: 14-18 months). Functional results were evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) score, visual analog scale (VAS) score, and Mayo elbow performance score. Mean flexion was 135° (range: 128-140°) at 24 weeks postoperatively; there was no loss of pronation and supination of the forearm. All fractures healed uneventfully in an average of 19.3 weeks (range: 16-24 weeks). Mean Mayo elbow performance score and DASH score at 24 weeks improved from 66.6 (range: 50-85) to 100 and from 53.6 (range: 25.75-80.75) to 12.7 (range: 5-26.5), respectively. VAS score at 24 weeks improved from 4 (range: 3-5) to 0.5 (range: 0-1). Postoperative radial nerve paralysis and infection were not observed. We recommend anterolateral anatomical locked plate fixation using a lateral approach as an alternative method in the management of distal humeral extra-articular fractures. This enables rigid fixation of the distal fragment without interfering and impinging on the olecranon fossa, allows early active range of elbow motion, and avoids iatrogenic triceps muscle injury and radial nerve exposure, which prevents surgical radial nerve injury.