Results of Surgical Treatment of Distal Humerus (AO/OTA Type C) Fractures Using Double Anatomical Plates

Abstract

Objective: Distal humerus fractures are complex injuries that are particularly challenging to treat. For predictable outcomes and early joint mobilization, they should be surgically treated using double anatomical locking plates. However, several complications have been reported, such as stiffness, decreased range of motion, nerve dysfunction, posttraumatic degenerative changes, and wound and skin infections. The purpose of this study was to report the outcomes and complications after open reduction and internal fixation of intra-articular distal humerus fractures using double anatomical locking plates. Materials and Methods: Between April 2010 and May 2013, we treated 11 patients with intra-articular distal humerus fracture (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association [AO/OTA] type C). Four patients were male and 7 were female. The average age was 47.0 (range, 22-80). The pretreatment AO/OTA type was C1 in 2 patients, C2 in 6, and C3 in 3. All fractures were treated with open reduction and internal fixation using double anatomical locking plates. Intraoperative ulnar nerve anterior transposition was performed for 10 patients. Postoperative immobilization was 1 week followed by active range of motion. Results: All patients obtained bone union. Regarding range of motion, mean elbow flexion arc was 106.5° (mean extension was −11.5° and mean flexion was 118°). The Mayo Elbow Performance Score was excellent in 4 patients, good in 6, and fair in 1. Radiographic evaluation was performed immediately and 6 months after surgery. There was no significant reduction loss between these time periods. Postoperative complications in the 10 cases included 7 with ulnar nerve neuropathy (3 with motor weakness and 4 with sensory disturbance), 2 with refixation of the olecranon, and 1 with infection. All patients with motor weakness improved and 5 patients had persistent numbness. Conclusions: No significant reduction loss was seen between the postoperative radiological evaluation performed immediately after surgery and that performed 6 months after surgery. For treating distal humeral intra-articular fractures, double anatomical locking plates can provide good stability for early active mobilization. However, this surgical method includes some complications, especially ulnar nerve dysfunction. Because gentle management of the ulnar nerve is necessary, hand surgeons should perform this surgery.