Operative Management Of Intercondylar Fractures Of The Distal End Humerus In Adults

Abstract

This is a prospective study which includes 26 adult patients of intercondylar fracture of distal humerus, both male (20 patients) and female (6 patients) of different age group treated with open reduction and internal fixation with 4.5 mm malleolar screw or 6.5 cancellous screw and reconstructed condyles of the humerus were fixed to the diaphysis with either dual reconstruction plates or one third tubular plates or small fragment DCPs preferably via trans-olecranon approach. Immediate post operative mobilization was started as patient was pain free. Most of the patients (50%) were between age group of 21-40 years. Mode of injury in 18 (70%) cases was road traffic accident and rest cases were due to fall from height. 20 cases (77%) belong to AO/ASIF classification C1 and14 case (54%) belong to Riseborough and Radin’s classification type III. 22 (85%) of 26 cases showed timely union at 18 weeks. Pain and stiffness in 3 (11.5%) patients, implant loosening in 3 (11.5%) patients were the common complications of this study. In our study 13 (50%) patients had range of motion (ROM) between 100 and 120 degrees. Based on Jupitar et al system 20 patients (77%) had ‘Excellent’ to ‘Good’ results and 6 patients (23%) had fair to poor results. INTRODUCTION Intercondylar fractures of the distal humerus are relatively rare and difficult to manage. Since the original description by Desault in 1811, the intercondylar fracture of distal humerus remained one of the most difficult of all the fractures to manage. Although it is a less common fracture, but in the past few years the incidence is increasing due to modernization and increased road traffic accidents. MECHANISM OF INJURY Wilson and Cochrane (1928), described mechanism of injury. They suggested that the separation of condyles in this type of fracture may be created by the splitting effect of humeral shaft as it is forced distally. The injury can occur either in flexion or extension of elbow. The fracture is probably caused by the impact of olecranon in the trochlear groove thereby diverging the condyles of distal humerus apart. MATERIAL AND METHODS This is a prospective study which includes 26 adult patients of intercondylar fracture of distal humerus, both male and female of different age group treated in the Department of Orthopaedics, Government Medical College Jammu. Once the General Condition stabilized, patients were sent for Xrays and fracture was classified according to AO/ASIF as well as Riseborough and Radins’s classifications. However compound fractures were thoroughly irrigated with Normal saline, antiseptic dressing done, limb splinted and then sent for x-rays. OPERATIVE TECHNIQUE ANAESTHESIA AND POSITION General anaesthesia was given and then patient was turned in either lateral or prone position with elbow flexed at 90 and supported on one side of the table. Tourniquet was applied; whole of upper limb was painted with iodine solution and draped with sterile sheets. Tourniquet was inflated and time noted. APPROACH About 20 cm long incision was given extending about 10 cm proximal and 10 cm distal to the elbow joint on the posterior aspect. Subcutaneous tissue and fascia was incised in the line of skin incision. Ulnar nerve is identified first and is retracted medially with a finger of gloves. Fracture site was exposed either through a trans-olecranon approach or campbell’s posterior approach. Assembling of fragments of distal humerus: (1)Reduction and fixation of condyles: Operative Management Of Intercondylar Fractures Of The Distal End Humerus In Adults 2 of 6 Both the condyles were reduced and held together with the help of bone holding clamps. Condyles are temporarily fixed with K-wires and then with 4.5 mm malleolar screw or 6.5 mm cancellous screws of adequate length. K-wire is now removed and stability as well as congruity of joint surface was assessed. ii) Reduction and fixation of condyles to metaphysis After the reduction of condyles to the humerus metaphysis, fixation is done with either single or dual (contoured) reconstruction plates or one third tubular plates or sometimes small fragment DCP and cortical screws. K-wires, malleolar screws or cancellous screws can be used in addition. When transolecranon approach was used, the osteomised olecranon was re-fixed with Tension Band wire.