Functional outcome of internal fixation of complex intraarticular fractures of the distal humerus (OTA-AO type-C) in focus of O’Driscoll criteria for optimized stability

Abstract

Introduction Internal fixation of distal humeral fractures is challenging because of complex anatomy and articular or metaphyseal comminution. Bi-columnar locked plating (orthogonal or parallel) is the standard method of fixation the success of which requires a rigid stable construct to optimize stability. The aim of this retrospective study was to evaluate the outcome of fixation of type-C distal humeral fractures by orthogonal locked plates and to determine the causes of early mechanical failure according to O’Driscoll criteria of optimized fixation stability. Settings and design A retrospective study conducted in Benha University Hospital. Patients and methods A review of 34 patients with type-C distal humeral fractures fixed with orthogonal anatomical locking plates through the period from 2014 to 2019, and evaluation of their outcome after 24–36 months. Radiographic images were reviewed for O’Driscoll criteria of optimized fixation, and complications were recorded. Results Functional outcome was assessed with Mayo elbow performance score. Twenty patients had an excellent outcome, seven patients good and seven fair in whom, O’Driscoll criteria for optimized fixation stability were not met and fixation was revised. All patients showed radiological union of fractures after about 3 months from definitive fixation. Multivariate analysis of the collected data was done by SPSS software to determine the cumulative percent of its factors and its relation with the final outcome. Conclusion Internal fixation of type-C distal humeral fractures by anatomically precontoured locking plates must be optimized according to O’Driscoll criteria to avoid early mechanical failure, revision surgery, and to achieve satisfactory functional outcome.