Abstract
BackgroundManagement of distal humeral fractures remains to be one of the most challenging aspects in trauma surgery. Low profile plating systems with variable angle screw fixation represent a crucial advancement to the established angular stable locking plates with considerable attention in current research. The aim of the prospective randomized trial was to review the preliminary results and patients’ outcome following treatment with these newly developed implants and to rule out potential differences in fracture treatment of two different plating systems.MethodsTwenty patients with distal humeral fractures (AO 13-A1 – AO 13-C3) were included in the current study since 2014. After completing the randomization plan, patients were distributed into two groups for different variable angle locking plates (DePuy Synthes® VA-LCP vs. Medartis® Aptus Elbow). Functional elbow scoring (ROM, MEPS, QuickDASH) served as primary outcome parameter, while radiological fracture consolidation served as secondary outcome parameter. Follow-ups were conducted 6 weeks, 12 weeks, 6 months and 12 months after the operation.ResultsSeventeen of 20 patients (85%) concluded all follow-up examinations. Postoperative elbow extension deficiencies showed significant differences between the two groups in all follow-up examinations with a mean of Ø 18 +/− 7.4 degrees in the DePuy Synthes® VA-LCP group compared to a mean of Ø 6.5 +/− 7.5 degrees in the Medartis® Aptus Elbow group (p = 0.002) 12 months postoperatively. Functional scoring showed a disparate pattern. The Medartis® Aptus Elbow group achieved significantly better MEP scores during follow-up. However, the analysis of the QuickDash revealed better results of the DePuy Synthes® VA-LCP group in the first half and better results of the Medartis® Aptus Elbow group in the second half of the follow-up examination instead.ConclusionsConsidering the complexity of distal humeral fractures, the usage of anatomically preshaped low profile variable angle locking plates for operative treatment leads to good clinical results. Even though there might be some advances of the Medartis® Aptus Elbow plating system concerning postoperative ROM and elbow function, a consistent difference in the overall clinical outcome between the two plating systems could not be detected.Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT03272490 Retrospectively Registered 1. September 2017.
Highlights
Management of distal humeral fractures remains to be one of the most challenging aspects in trauma surgery
Considering that, conservative treatment frequently leads to a painful limited range of motion (ROM) quite often
As an advancement to the known angle stable locking plates where screws can only be placed in the predetermined direction, low profile plating systems with a variable angle for screw fixation gain considerable attention in current research
Summary
Management of distal humeral fractures remains to be one of the most challenging aspects in trauma surgery. Concerning the complex fracture pattern of these fractures together with the growing age of the patients, management remains to be one of the most challenging aspects in modern trauma surgery [2] Dealing with these challenges, a large variety of different treatment options can be found in current literature, ranging from conservative treatment [3, 4] to different operative fixation techniques [5,6,7,8] up to total joint replacements [9]. The usage of anatomically preshaped plates with variable possibilities for angular stable screw fixation already showed promising results in dealing with various complex fracture types like distal femur fractures [13], distal tibial fractures [14], distal radial fractures [15], clavicle fractures [16] or radial head fractures [15, 17] Little about these modern implants is known in terms of dealing with distal humeral fractures
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
