Utilization of 1.25mm wire and locking plate fixation for a comminuted low transverse distal humerus fracture, a case report of a 78-year-old woman.

Abstract

Introduction Low transverse distal humerus fractures can be challenging to treat in elderly populations—especially when there is severe comminution or underlying bone demineralization. Current operative interventions include total elbow arthroplasty or open reduction internal fixation (ORIF) with traditional plate and screw fixation. Herein, we present a unique case utilizing Kirschner wires (K-wires) and locking plate fixation as an alternative approach to managing low transverse distal humerus fractures. Case A 78-year-old right-hand dominant retired female presented with a displaced, comminuted, low transverse distal humerus fracture secondary to a fall from standing. Fixation of this fracture was achieved through a slight modification of the skinny K-wire and locking plate technique described by Olson et al. in 2021. Methods A triceps-sparing approach to the distal humerus was conducted through a direct posterior incision. The low transverse extra-articular fracture was identified and anatomically reduced. A posterior medial distal humerus plate was secured to reduce the medial column with 1.25x150mm K-wires subsequently placed through the trochlea. The K-wires were then bent as they exited the lateral side and cut short in the metaphysis, approximately 90° to the shaft of the humerus. After which, a posterolateral distal humerus plate was used to secure the lateral epicondyle and secures the K-wires beneath it. Results Seven weeks after the procedure, the patient had regained 81% elbow arc of motion, with a complete return of grip strength, pronation, and supination. At this time, radiographs demonstrated satisfactory bone healing, and the patient surpassed all therapy goals. Conclusion Our case demonstrates the modified use of the 1.25mm K-wire and locking plate technique as a satisfactory treatment option for comminuted low transverse distal humerus fracture in a 78-year-old female who sustained a ground-level fall. Ultimately resulting in the rapid return of function by postoperative week seven.