Funktionelle Ergebnisse nach winkelstabiler Osteosynthese der distalen Humerusfraktur mit einem anatomisch präformierten Doppelplattensystem

Abstract

The aim of this study was to evaluate the functional results and determine/record the complications after treating distal humerus fractures with an anatomically precontoured and angular-stable double plate system (LCP Distal Humerus Plates, Synthes GmbH, Umkirch). 51 patients (30 female, 21 male) with 52 fractures of the distal humerus and a mean age of 51 years (14-94) were prospectively recorded over a period of 42 months and treated by open reduction and internal fixation using the above-mentioned LCP Distal Humerus Plates System. Follow-up was performed in 44 patients with 45 fractures after a mean of 13 months (6-24). According to the classification system introduced by the "Arbeitsgemeinschaft für Osteosynthesefragen" (AO [Association for the study of internal fixation, ASIF]) there were six A fractures (13.3%), five B fractures (11.1%) and 34 C fractures (75.5%). The AO/ASIF rate of type C3 fractures was 53%. Seven fractures were grade I (15.6 %) and three fractures grade II (6.7%) open. In addition to clinical examination and measuring range of motion (ROM), functional results were evaluated using the Mayo elbow performance score (MEPS) and the disabilities of the arm, shoulder and hand score (DASH). Using the MEPS, excellent results were achieved in 19 patients (43.2%), good in 23 (52.3%), fair and poor each in one. Mean MEPS was 87.5 +/- 11.8 points (50-100). The mean DASH score reached 14.2 +/- 19.9 (0-65.8). Having a mean extension deficit of 10 +/- 14.1 degrees (0-40 degrees) and flexion up to 127.5 +/- 17.2 degrees (80-145 degrees), the mean ROM was 110 +/- 23.8 degrees (50-145 degrees). A primary stable osteosynthesis which allows early physiotherapy was gained in 38 fractures, in seven cases additional immobilisation was carried out (10 to 28 days). Postoperative complications were seen in eleven patients (24.4%). Overall revision surgery was necessary in nine cases. By using the anatomically precontoured and angular-stable LCP distal humerus plates system a stable osteosynthesis allowing early physiotherapy is achieved in the majority of patients. Due to early initiation of physical therapy the functional results might be improved. Despite using the LCP system complications at the distal humerus fracture side were seen frequently, emphasising the challenging surgical procedure and demonstrating the need for further implant and surgical procedure improvement.