Abstract
Introduction: Surgical treatment of distal humerus fractures can lead to numerous complications. Data suggest that the number of screws in the distal (articular) segment may be associated with complication rate. The purpose of this study is to evaluate the association between a number of screws in the distal segment and complication rate for surgical treatment of distal humerus fractures. We hypothesize that the number of screws in the articular segment of distal humerus AO/OTA C-type fractures treated with open reduction internal fixation (ORIF) will be inversely proportional to the complication rate. Methods: We performed a single-center retrospective cohort study of 27 patients who underwent ORIF of distal humerus fractures C-type with at least six months of radiographic and clinical follow-up. Clinical outcomes including a range of motion, pain, revision surgery for stiffness and/or heterotopic ossification (HO), nonunion, and persistent ulnar nerve symptoms requiring revision neurolysis were recorded. Results: In C-type fractures, the use of three or fewer articular screws was significantly associated with nonunion or loss of fixation (RR 17, p = 0.006). Nineteen of 36 (53%) patients experienced at least one complication. The surgical approach, plate configuration, age, and ulnar nerve treatment (none, in situ release, transposition) were not associated with the need for revision surgery. Men had a higher risk of requiring surgical contracture release due to improving post-operative stiffness (RR 12, p = 0.02). Conclusion: In this retrospective study, the use of three or fewer screws to fix articular fragments in AO type C fractures was a significant risk for nonunion or loss of fixation. Plate configuration and surgical approach did not correlate with outcomes. Men had higher rates of complications and required more frequent revision surgery compared to women.
Highlights
Fractures of the distal humerus make up 2–6% of all humeral fractures and 30% of all elbow fractures [1]
Clinical outcomes including a range of motion as measured with a goniometer, pain, revision surgery for stiffness and/or heterotopic ossification (HO), nonunion, other revision surgery, and persistent ulnar nerve symptoms requiring revision neurolysis were recorded
The average number of articular screws used in type C fractures was 5.2, with an average of 3.1 locking screws
Summary
Fractures of the distal humerus make up 2–6% of all humeral fractures and 30% of all elbow fractures [1]. These fractures can be difficult to treat surgically. Complications of distal humerus open reduction and internal fixation (ORIF) occur in up to 35% of patients [2,3,4]. They include nonunion, ulnar nerve injury, and stiffness secondary to heterotopic ossification, all of which may require revision surgery. Nonunion occurs in approximately 0–7% of cases [11,12,13] and heterotopic ossification has a varying prevalence in the literature
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