Articular Fractures Of Distal Humerus Research Articles

Linking the distal humerus columns in articular fracture fixation

IntroductionConcerning rates of nonunion in articular distal humerus fractures indicate an unsolved problem. The fixation principles of O'Driscoll describe linking the fractured articular segment to the distal humerus columns with compression screws which creates a stable fixed angle construct. A novel device has been introduced which utilizes an interlocking beam through the articular segment to connect the distal aspect of the medial and lateral plates, creating a linked construct. We sought to evaluate the stability of this linked construct using an articular model of distal humerus fracture. Materials and methodsTen matched pair specimens of 65 years of age or older were randomized to the use (LB group) or non-use (NLB group) of an interlocking beam to link the medial and lateral locking plates in fixation of an AO Type C3 fracture model. Outside of the linking beam, fixation between the matched pairs was consistent using 2.7 mm locking screws distally with fixed trajectories and +/- 2 mm lengths. ResultsMean stiffness was 273 Newtons/mm in the LB group and 225 Newtons/mm in the NLB group (p = 0.001). Mean maximum displacement was 0.28 in the LB group and 0.93 mm in the NLB group (p = 0.006). Mean load to failure was 277 pounds in the LB group and 280 pounds in the NLB group (p = 0.94). DiscussionOur results indicate that an interlocking beam which links the medial and lateral plates provides greater stability compared to a similar construct without an interlocking beam. We attribute this finding to the beam's double supported design which resists cantilever bending and provides robust compression of the fractured fragments.

Functional Outcome Of Extra-Articular Distal Humerus Fracture Fixation Using A Lateral Column Locking Compression Plate.

: A host of different methodologies have been implemented in the management of distal humerus fractures, including conservative measures and surgical fixation with a variety of plates. This study was conducted to evaluate the functional outcome of open reduction and internal fixation of extra articular distal humerus fractures with distal humerus locking compression plate. This is a retrospective cohort study of patients with close extra articular distal humerus fractures who underwent open reduction and internal fixation with a distal humerus locking compression plate at Ghurki Trust Teaching Hospital from July 2017 to December 2019. Various demographic indicators were used for data analysis and radiological union was assessed in serial follow-ups. Functional outcome was evaluated using the Mayo Performance Elbow Score at the final follow-up. Thirty-one patients presented with extra-articular fracture of humerus (N=31) with average age 33.5±9.90 years. The average follow-up period was 13.8 months. Radiological union was achieved in 14.8 weeks (range 12-20 weeks). Out of 31 patients, 28 had excellent results with mean Mayo Elbow Performance Score of 94.8. Two patients (6.5%) had radial nerve palsy post-operatively. This study shows that open reduction and internal fixation of extra-articular distal humerus fractures with distal humerus locking compression plates allows for stable fixation, good functional outcome, and low complication rates.

A New Technique of Fixing Intra-articular Fractures of the Distal Humerus without Exposing the Ulnar Nerve by Posterior Approach.

Distal humerus fractures constitute around 0.2 to 7% of all fractures, 30% of all humerus fractures, most common in young adults, are due to high energy trauma and in old age due to osteoporosis. A common step in all currently available approaches is to identify the ulnar nerve, expose, mobilise, and retract this from its surrounding bed or in situ release. Ulnar neuropathy is either observed immediately after surgery or delayed up to one year after surgery. We are describing a new posterior approach for intra-articular distal humerus fractures, where identification and retraction of the ulnar nerve are not required to fix the intra-articular fractures of the distal humerus, thereby avoiding injury to the ulnar nerve. Seven patients with AO type B and C were treated using our new ulnar nerve-sparing approach between January 2017 and December 2019. Postoperatively, all the patients have been examined for ulnar neuropathy symptoms. We have no ulnar nerve neuropathy either in the post-operative period or at 2 years follow-up (five cases were followed up for 2 years and two patients lost to follow-up after 6 months). At the end of 2 years, the mean range of motion achieved at elbow was 134°. The mean oxford elbow score was 45.2 (42-47). Heterotopic ossification and infection were not found in our cases. Our ulnar nerve-sparing approach for intra-articular fractures of distal third humerus by posterior approach helps in fixing articular fractures of distal humerus without exposing ulnar nerve during surgery without compromising on the exposure of fracture for fixation, thus reducing the chances of ulnar nerve injury and post-operative neuropathy.

Study on functional outcome of intra articular fractures of distal humerus managed by locking compression plate

<p><strong>Background:</strong> The primary goal in management of intra articular fractures of distal humerus is to achieve stable and mobile elbow. Type C fracture of distal humerus is a relatively uncommon fracture. Internal fixation is difficult but anatomical reduction is needed to prevent poor functional outcome and degenerative changes.</p><p><strong>Methods: </strong>Functional outcome of patients who underwent open reduction internal fixation with locking compression plates for intra articular fractures of distal humerus at the department of orthopedics, Government medical college Kottayam, from December 2017 to July 2019, were assessed using Mayo elbow performance index. A total of 30 patients were studied.</p><p><strong>Results: </strong>Excellent and good results were found in 25 cases, 3 patients had fair outcome and 2 patients had poor result. Complications encountered in our study were, infection (superficial treated with antibiotics-3 cases), heterotopic ossification (3 cases), hard ware prominence (2 cases) and non-union (1 case).</p><p><strong>Conclusions: </strong>Complications were minimal and outcomes were good in patients with type C distal humerus fractures who underwent bicolumn locking compression plates fixation by posterior approach.</p><p class="abstract"> </p>

A Study to evaluate the Functional Outcomes after the Surgical Management of Intra Articular Fracture of Distal Humerus

Introduction: The primary goal in management of intra articular fractures of distal humerus is to achieve stable and mobile elbow. The chances of functional impairment and deformities are very high following conservative treatment of such distal intra-articular fractures of humerus. Objectives of the study were to assess the functional outcome and to compare the results after surgical management of intra articular fracture of distal humerus using Mayo elbow performance index. & to assess the range of movements, pain and union. Methods: Retrospective Evaluation study with Review and Reports of 50 cases / patients, who were diagnosed & surgically managed. Fractures were classified as per AO type A to C (except C3 comminuted) and were included in this study in whom internal fixation was done using triceps reflecting Bryan Morrey approach with some modification in few cases. Results: No patient achieved complete extension. No limitation in the pronation-supination was detected. Radiographic assessment Postoperative and follow up radiographs showed adequate fracture reduction and fracture healing in all patients. No step off more than one mm was seen. All patients had completed postoperative physical therapy at the time of the study and had achieved maximum function of elbow. Conclusion: Triceps reflecting Bryan Morrey approach is a simple and effective approach that can be used in management of the majority of the distal humeral fractures as it provides adequate visualization and reduction fracture fragments with no adverse effect on triceps muscle strength

Evaluation of functional outcome after osteosynthesis of intra articular distal humerus fracture with pre contoured locking compression plates

<p><strong>Background:</strong> Intra articular distal humerus fractures are challenging and cumbersome to treat. Therefore osteosynthesis of such fractures is required. The aim of our study was to evaluate the functional outcome of intra articular distal humerus fractures AO type 13C by osteosynthesis using olecranon osteotomy with pre contoured locking compression plates in orthogonal plate configuration.</p><p><strong>Methods:</strong> Thirty patients were included in our study comprising of 18 males and 12 females. Mean age was 39.63 years with mean follow up of 34 weeks. 7 were AO type 13C1, 9 were AO type 13C2 and 14 were AO type 13C3. Osteosynthesis was done for all fractures by olecranon osteotomy approach. Functional outcome was assessed using mayo elbow performance score.</p><p><strong>Results:</strong> Mean flexion attained at the end of follow up was 127.56 degrees with mean extensor lag of 7.16 degrees. Mean arc of motion was 120.4 degrees. Mean mayo elbow performance score at the end of follow up was 80.36. Mayo elbow performance score in patients aged less than 40 years of age was not statistically significant as compared to patients more than 40 years of age. Functional outcome was also dependent on fracture subtype.</p><p><strong>Conclusions:</strong> Osteosynthesis of distal humerus fractures AO type 13C using pre contoured locking compression plates in orthogonal plate configuration by olecranon osteotomy provides excellent visualization of fracture and better functional outcome.</p>

Randomised prospective comparative analysis of functional outcome of osteosynthesis of intra-articular distal humerus fracture using triceps reflecting and transolecrenon approach

<p class="abstract"><strong>Background:</strong> Intra articular fractures of distal humerus is one of the demanding injuries to manage due to its complex anatomy. Open reduction internal fixation is able to achieve painless, stable and mobile joint. This study is aimed at comparing functional outcome of patients treated with triceps reflecting and olecranon osteotomy approach.</p><p class="abstract"><strong>Methods:</strong> A hospital based randomized comparative study of 40 patients who diagnosed with distal humerus intraarticular fracture admitted in our hospital from April 2017 to March 2019. Triceps reflecting approach (group A) was used in 20 patients and olecranon osteotomy approach (group B) in 20 patients. Elbow range of movements and Mayo elbow performance score (MEPS) was used to compare outcome.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean elbow range of motion is 95.8±13.5 degree at 1 year follow up in group A and 94.5±9.3 degree in 1 year follow up at 1 year follow up in group B. The mean MEP score at end of 1 year in group A was 93.8±2.9 and in group B was 91.5±3.2 shows excellent results but there was no statistically significant difference between MEP scores of two groups. We observed 6 patients developed extension lag less than 10 degree in group A which was clinically insignificant to patients and 7 patients developed hardware prominence in group B.</p><p class="abstract"><strong>Conclusions:</strong> Triceps reflecting Bryan Morrey approach is equally effective as olecranon osteotomy approach in treatment of distal humerus intra articular fracture with less complication and operative time.</p>

Functional outcome of treatment of extra articular distal humerus fractures using pre contoured distal humerus locking compression plate: A retrospective study

Methods: This retrospective study was carried out at Integral Institute of Medical Sciences And Research, Lucknow from September 2013 till August 2016. Out of the 47 patients records analysed, only 25 patients qualified for this study. All the patients were operated using the posterolateral triceps reflecting approach to the humerus. All the fractures were fixed using extra-articular distal humerus locking plates. All the patients were followed for 12-18 months with a mean of 16 months. The clinical and functional outcome was assessed using the Mayo Elbow Performance score (MEPS) for elbow and University of California Los Angeles (UCLA) rating scale for the shoulder function.

Elbow Hemi-Arthroplasty for Intra-Articular Distal Humerus Fractures: Results and Technique

To introduce elbow hemiarthroplasty as a novel alternative treatment for comminuted, articular distal humerus fractures.

A prospective study: Functional outcome of intra-articular distal humerus fractures treated with bicolumnar locking plates in Indian population

Background: Distal humerus fractures in adults are relatively uncommon and intra articular injuries amounting to 2 to 6 % of all fractures and 30 % of all elbow fractures. The complex shape of the elbow joint, the adjacent neurovascular structures make these fractures difficult to treat. Open reduction and surgical fixation with plating gives good results. The Aim of our study is to evaluate the functional outcome of intra-articular distal humerus fractures by open reduction and internal fixation using bicolumnar plating technique.Materials and Methods: A total of 20 intra articular distal humerus fractures were operated between june 2016to June 2019 were included in the study. All patients are above the age of 18 years. All the patients were operated with pre-countered distal humerus locking plates in orthogonal fashion and outcome was measured by MEPS, rate of union, rate of complications and final range of motion.Results: In our series of 20 cases, there were 14 males and 6 females. 6 cases were due to self-fall, 12 were due to RTA and two due to assault. Out of 20 cases,1 (5%) were of C1 type of fractures, 16(80%) were of C2 and 3 (15%) were of C3 type of fractures. The average duration of the radiological union was 13±04 weeks. Excellent results were seen in 10, good in 6 and fair in 3, and poor in 1, according to MEPS. 2 patients had transient radial neuropraxia and 1 had transient ulnar neuropraxia in early postoperative period.Conclusion: To get good functional results with good range of movement and fracture union, precise preoperative planning, adequate surgical approach, anatomical inter fragmentary stabilization, Operative treatment with stable anatomical internal fixation gives best chance to achieve good elbow function.

Paratricipital two window approach for complex intraarticular distal humerus fractures: A prospective analysis of 27 patients

BackgroundTo investigate the utility and complications of paratricipital 2 window approach for complex intra articular distal humerus fractures (AO/OTA type C). MethodsBetween December 2012 and September 2016 , 27 patients (male-14, female-13) having mean age of 39 years (range, 22–62 years) with closed intra articular fracture (AO/OTA 13 type C) were surgically managed using paratricipital 2 window approach. Fractures were fixed as per AO principles. All patients were followed up for 21 months (range, 12–28 months) prospectively. Functional outcome was measured using Mayo Elbow Performance Score (MEPS) and complications were observed. Student t-test, Pearson co-relation coefficient and Kruskal Wallis test used for statistical evaluation. ResultAll cases unite by the end of 3 months. Mean flexion achieved was 120° and extension lag was 10°. Mean arc of motion was 111°. Mean pronation and supination was 70° and 77° respectively. MEPS and motion arc were weak negatively co- related with surgical delay and advancement in age. Post-operative transient ulnar nerve palsy and heterotrophic ossification (HO) was noted in 3.7% cases and infection occurred in 7.4% cases. Hardware prominence noted in 11.1% cases. Mean MEPS was 82. MEPS was excellent in 18.5%, good in 62.9%, fair in 11.1% and poor in 7.4% cases. ConclusionParatricipital 2 window approach for these fractures had good functional outcome with fewer complications. We advocate paratricipital 2 window approach when dealing with these complex fractures particularly, in type C1 and type C2.

Functional outcome of locking anatomical plate in extra articular fractures of the distal humerus

<p class="abstract"><strong>Background:</strong> Extra articular distal humerus fractures are difficult to treat with conventional implants like intra medullary nail, 4.5 DCP and dual plate. The present study aims to study the functional outcome of the extra articular distal humerus plate (EADHP).</p><p class="abstract"><strong>Methods:</strong> 48 patients with displaced extra articular distal humerus fractures were included in the study. Inclusion criteria were age more than 18 years, closed fractures with or without radial nerve palsy and less than 3 weeks old trauma. Patients aged less than 18 years, those having open fractures, fractures more than 3 weeks old, non – unions and pathological fractures were excluded from the study. All patients were operated with EADHP. Clinically, the outcome was assessed by the disability of arm, shoulder and hand (DASH) score and elbow range of motion radiologically, union was evaluated on anteroposterior and lateral radiographs.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 48 patients, 12 had AO type 12 A1 fracture, 26 patients had type B1 fractures and remaining 10 had type C1 fractures. Mean DASH score at final follow up was 18.1; range being 12.6 to 35.7 points. The mean elbow range of motion was 0 to 130 degrees (range: 120 to 140 degrees). The mean duration for complete radiological fracture union was 14 weeks, range being 12 to 18 weeks.</p><p class="abstract"><strong>Conclusions:</strong> The extraarticular distal humerus plate is an ideal implant for the fixation of distal humerus fractures since it provides good stability of fracture and enables early return to function.</p>

Functional evaluation of intra articular fractures of distal humerus in adults after open reduction and internal fixation

Functional evaluation of intra articular fractures of distal humerus in adults after open reduction and internal fixation

A prospective study of functional outcome in intra articular distal humerus fracture treated with dual plating

Background: In adults, distal humerus fractures are uncommon and intra-articular, oftenly involve both the medial and lateral columns. Open reduction and surgical fixation with plating gives good results. The aim of this study is to evaluate clinical outcome in intra articular distal humerus fractures treated with dual plating and evaluate the intermediate term results (minimum follow up of two years) of communited intra-articular distal humerus fractures treated with bicolumnar plating with or without olecranon osteotomy in elderly Indian population. Methods: This is a prospective type of study of 20 cases of supracondylar fracture humerus with inter condylar extension treated surgically with dual plating which were admitted to Jaya Aarogya Hospital & Trauma Center, Gwalior, Madhya Pradesh, between 2015 to 2016. All the patients of supra condylar fracture distal humerus with age between 18 to 60 years with medical fitness for surgery were included in the study. Results: The mean age of the patient was 40±2 years, 12(60%) cases were males, and 8(40%) cases were females. Right sided involvement was more frequent in the present study 13(65%) cases. 14(70%) cases sustained fracture due to road traffic accident, 06(30%) cases had a domestic fall. The average duration of surgery was 94±10 mins. The average duration of the radiological union was 14±06 weeks in 12(60%) cases, 15±04 weeks in 5 (25%) cases, 19±05 weeks in 3 (15%) cases. The outcome was calculated using the ASES and DASH scores. The American shoulder and elbow surgeons score showed excellent in 5 (25%) good in 11 (55%) fair in 4(20%) and no poor outcome. Conclusions: For good functional results, precise preoperative planning, adequate surgical approach, anatomical inter fragmentary stabilization, medial-post erolateral plating, and early post-operative physiotherapy help in restoring painless and functional elbow for distal humeral intra-articular fractures. This step-by-step approach results in satisfactory functional results.

Does timing of surgery affect the outcome of open articular distal humerus fractures

Open intraarticular distal humerus fractures classified as Orthopaedic Trauma Association (OTA) 13 C may have devastating consequences for patient's quality of life, especially if leading arm in younger active patient is involved. We conducted a study to determine whether the timing of open reduction and internal fixation of open intraarticular distal humerus fractures affects the outcomes. Multicentric prospective study: In the first group, there were 15 patients, 10 men and 5 women, mean age 38.7 years, operated in <6 h of injury. In the second group 17 patients, 11 men and 6 women, mean age 42.3 years operatively treated in delayed settings, mean delay to operation 4.6 days of injury. In both groups, patients had open distal humerus articular metaphyseal multifragmentary fractures classified as OTA 13.C2 or 13.C3. Functional outcome was assessed with Mayo elbow performance score and Disabilities of Arm and Shoulder and Hand (DASH). Mean Mayo elbow performance (MEP) score in the first group was 71 (range 30-100); in the second, mean MEP was 64.3 (range 25-100). The mean DASH in the first group was 27.89 (range from 1.7 to 75.8), and in the second, mean DASH score was 32.6 (range 5.8-77.5). There were no statistically significant differences between two groups, MEP t(28)=0.935, p<0.358; DASH t(28)=-0.636, p<0.530. Our study shows that early open reduction and internal fixation of open distal articular humerus fractures reduces the hospital stay, but does not significantly affect the overall outcomes and complications.

Treatment of distal humerus fractures with LCP DHP™ locking plates in patients older than 65 years

Fractures of the distal humerus are often complex and therefore challenging to treat. In elderly patients with decreased bone strength due to osteoporosis, strong fixation is crucial to allow resuming early motion that guarantees a good functional outcome as well as minimising mechanical complications. Locked implants meet these requirements. Here, we report outcomes in a uniform series of patients older than 65 years with distal humerus fractures managed with LCP DHP(®) (Synthès) fixation. Our objective was to evaluate the efficacy and limitations of this technique. LCP DHP provides strong fixation of osteoporotic bone and leads to good clinical and radiological outcomes. We retrospectively studied 46 consecutive patients (2004-2010) with a mean age of 80 years including 15 with extra-articular and 31 with articular distal humerus fractures. At presentation, 11 complications were noted in nine patients (compound fractures and trauma-related nerve injuries). The transolecranon approach was used in 31 patients. Mean duration of immobilisation was 2.7 weeks in 33 patients. Forty-three patients were re-evaluated after a mean follow-up of 25 months (range, 10-64 months); two patients died and one was lost to follow-up. Flexion was 127° and loss of extension was 23°, producing an average range of motion of 104°. Functional recovery was highly satisfactory with a Mayo Clinic Performance Score of 87 (70-100) and 95% of good and very good results. Postoperative complications consisted of infection (n=3), metaphyseal non-union (n=2), ulnar nerve injury (n=6), transient radial nerve palsy (n=1), and peri-articular ossification (n=4). Compound fracture and worse AO fracture type were associated with worse functional outcomes. Despite the high complication rate, functional recovery was similar to that reported in previous case series, including after arthroplasty. Furthermore, the rate of mechanical complications was lower. Thus, our working hypothesis was confirmed. Level IV retrospective non-comparative study.