Distal Humerus Fractures Research Articles

Outcomes at mean follow-up of four years following AO type-C distal humerus fractures managed with fixation or arthroplasty.

To compare outcomes between open reduction internal fixation (ORIF), total elbow replacement (TER) and distal humerus hemiarthroplasty (DHH) for AO type-C (AOC) fractures of the distal humerus in patients aged 50 years or older. A retrospective analysis of acute AOC distal humerus fractures in patients aged 50 years or older between 2016 and 2022. Outcomes measured: Oxford Elbow Score (OES), Mayo Elbow Performance Score (MEPS), complication rate, re-operation rate and range of movement (ROM). Sixty-five patients met the inclusion criteria (20 males, 45 females). Mean age was 64.4, 77.1 and 61.3 years old for ORIF, TER and DHH respectively. Logistic model analysis revealed a statistically significant increased complication rate in the ORIF group compared to the TER and DHH groups (ORIF vs TER p = 0.01; ORIF vs DHH p = 0.048). There was a higher re-operation rate in the ORIF group compared to the DHH group (p = 0.03). There were no differences in OES, MEPS or ROM between groups. This supports the use of TER in elderly patients with AOC distal humerus fractures. In the younger patient, DHH may have lower rates of complications and re-operations compared to ORIF, but function remains similar. We propose a prospective randomised control trial.

'Low-Plane' Fractures of the Distal Humerus in Elderly Patients with Osteoporosis Show High Postoperative Complication Rates.

Background: This study aimed to investigate the fracture patterns and complexity of distal humerus fractures with high-resolution computed tomography (CT) as a function of Dual-Energy X-ray absorptiometry (DXA)-derived bone marrow density (BMD) measurements in an elderly patient cohort. Methods: A retrospective chart review was conducted on patient data collected at a Level I trauma center between January 2007 and January 2022. Inclusion criteria comprised patients aged ≥40 years with a confirmed distal humerus fracture as demonstrated by CT. Additionally, patients were included if they underwent DXA. Patient demographics and detailed information regarding the surgical treatment and trauma mechanism were retrieved from the institutional databank. Fractures were classified as either 'low-plane' distal humeral fractures or 'non-low-plane' distal humerus fractures. Furthermore, the fracture patterns were classified according to established classification systems. Intra- and postoperative complication and revision rates were analyzed. Results: A total of 41 patients (30 women; mean age 74 ± 13 years) were enrolled. Low-energy trauma was sustained by 68% of the patients. The remaining 32% of the fractures involved medium-energy trauma. A total of 62% of the patients underwent primary osteosynthesis, while 30% of patients were initially treated with an external fixator. ORIF was performed in 89% of cases and, in the majority, double-plate osteosynthesis was used (76%). An olecranon osteotomy was performed in 30% of cases. A total of 5% of cases received total elbow arthroplasty, and 10% of cases were treated conservatively. A total of 61% of patients had osteoporosis, 24% of patients had osteopenia, and 15% of patients had a normal BMD with an overall mean T-score of -2.4. Most of the fractures were complex (including 61% Type C fractures). A total of 66% of cases were considered as 'low-plane' fractures. Postoperative complications occurred in 11% of patients (64% of cases among 'low-plane' fractures). Revision surgery was required in 20% of cases. Conclusions: The consecutive series of patients showed a high incidence of 'low-plane' fractures. However, no statistical significance was found between the BMD and fracture complexity. The very distal 'low-plane' fractures showed a high complication rate, which was aggravated by osteoporotic bone conditions. These findings highlight the need for future research with larger patient samples to better understand the relationship between the BMD, fracture complexity, and outcomes in patients with 'low-plane' fractures in order to reduce complications and improve clinical outcomes.

METHODS OF PERCUTANEOUSFIXATION OF FRAGMENTS IN SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN AND ADOLESCENTS

The aim of this study is to conduct a meta-analysis and evaluate the clinical efficacy and safety of crossed and lateral fixation of fragments in supracondylar humerus fractures in children and adolescents. Methods. A comprehensive literature search was conducted in the PubMed and EMBASE databases from 2015 to December 2023 using the following search terms: "supracondylar fractures of distal humerus in pediatric patients", "treatment", "methods of fixation", "pinning configuration", "biomechanical analysis of pin placement". According to the inclusion and exclusion criteria, the literature sources of anatomic-biomechanical and clinical studies related to the use of crossed and lateral fixation of fragments in the case of supracondylar fractures of the humerus in children and adolescents were selected and analyzed. The review was prepared in accordance with the recommendations of the "Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines." Results. A comparison of results from experimental studies investigating the degree of stabilization achieved in the crossed and lateral configurations of fixation structures reveals conflicting conclusions due to the heterogeneity of designs implemented. The principal limitation of lateral fixation is the increased risk of failure of fixation. The outcomes of clinical trials (Flynn criteria) demonstrate that both types of fracture fixation yield equivalent clinical outcomes. One disadvantage of crossed fixation is the risk of iatrogenic ulnar nerve damage, while another disadvantage is the increased complexity of the surgical technique. Conclusions. The results of anatomical and biomechanical studies indicate that cross-fixation provides more rigid fixation of fragments in supracondylar humerus fractures in children and adolescents. Nevertheless, clinical outcomes based on radiological and functional data (including Flynn's score) demonstrate no significant distinction between the two types of fixation configurations. However, they do indicate a notable risk of iatrogenic ulnar nerve damage in cross fixation, which justifies the necessity to utilise a mini-open technique in the medial fixation construct.

Comparison of Decontamination-Preservation Protocols for Delayed Surgical Re-implantation of Osteoarticular Fracture Fragments

Background: To avoid discarding contaminated, devascularized osteoarticular fragments required for joint reconstruction, fragments need to be decontaminated while preserving chondrocyte viability. We hypothesized that disinfection with povidone-iodine or chlorhexidine followed by preservation using the Missouri Osteochondral Preservation System (MOPS) would allow for effective decontamination while retaining essential chondrocyte viability in osteoarticular fracture fragments for up to 14 days of shelf-stable point-of-care storage. Methods: With IACUC approval, purpose-bred hounds (n=16) were humanely euthanized for unrelated purposes and subjected to captive bolt trauma to create open distal humeral fractures. For each elbow (n=32), humerus, radius and ulna tissues were recovered such that 96 contaminated, devascularized osteoarticular fragments were randomly allocated to one treatment: Betadine (n=42): saline irrigation (1L), immersion in 10% povidone-iodine (20 min), saline irrigation; Chlorhexidine (n=42): saline irrigation, immersion in 0.002% chlorhexidine gluconate (20 min), saline irrigation; Injured Control (n=12): no decontamination treatment. After 7 or 14 days in MOPS, tissues were assessed by quantitative microbial culture and Viable Chondrocyte Density (VCD) measures. Results: Captive bolt trauma consistently resulted in type 3 open articular fractures. Injured Control osteoarticular fragments produced high polymicrobial counts at days 7 and 14. Chlorhexidine treatment was effective for decontaminating fragments such that no CFUs for clinically relevant bacteria were produced, while Betadine treatment was not fully effective at decontamination. Chlorhexidine decontamination followed by MOPS preservation maintained VCD in osteoarticular tissues over the desired 70% mean for 14 days, whereas the Injured Control group was associated with significant loss of VCD (Day-7=59%, Day-14=13%), which was further exacerbated by Betadine treatment (Day-7=29%, Day-14=6%). Conclusion: Contaminated, devascularized osteoarticular fracture fragments can be effectively decontaminated while maintaining essential chondrocyte viability for 14 days after type 3 open articular fractures using a decontamination-preservation protocol that combines saline irrigation with 0.002% chlorhexidine immersion followed by shelf-stable point-of-care storage in MOPS.

Long-term outcomes and trends in elbow arthroplasty with Coonrad-Morrey prosthesis: a retrospective study in large group of patients.

Total Elbow Arthroplasty (TEA) was first developed to treat severe rheumatoid arthritis, but its uses have grown to encompass end-stage osteoarthritis, post-traumatic arthritis, and distal humeral fractures. This study analyzes indications changes, long-term survival, complications, and post-operative functional results of the Coonrad-Morrey prostheses, enhancing the existing literature on this technique and substantial case history. We included 122 arthroplasties in 117 patients, 28 males and 89 females (mean age of 67 years) treated in our hospital between 2002 and 2016. Minimum follow-up was four years. We collect functional parameters of 48 patients (51 elbows), due to death of patients due to old age and loss at follow-up. Survival rate at five years was 90%, 85% at 10 years and 83% at 15 years. The overall medium Mayo elbow score was 79.7 ± 18.3 with the highest result in osteoarthritis patients (p < 0.005); QuickDASH score was 33.1 ± 25.5 with the worse result in rheumatoid group. Average post-operative arc of motion (ROM) was 95°±27°. There were complications in 46 out of 122 cases (37.7%) and revision surgeries were performed in 12 of them (9.8%): seven aseptic loosening, four late septic loosening, one bushing wear. In 27 instances (22.1%) was reported ulnar nerve involvement. Coonrad-Morrey prosthesis has shown satisfactory clinical results in the treatment of a wide range of pathologies. The long-term implant survivorship was satisfactory, yet the occurrence of failures and complications cannot be overlooked, above all the ulnar nerve paresthesia. There was a good recovery in quality of life, pain-free with limited residual limb disability.

A preclinical model for osteoarticular fracture fragment preservation for delayed re-implantation

BackgroundOpen articular fractures often include contaminated, devascularized osteoarticular fragments that are critical for joint reconstruction. Definitive treatment is often delayed such that decontamination and preservation of critical fragments for joint reconstruction is highly desirable. To validate decontamination and preservation protocols for safe and effective preservation of osteoarticular fragments for re-implantation, a preclinical animal model for inducing type 3 open articular fractures with contaminated, devascularized osteoarticular fragments was developed and validated. Materials and methodsWith IACUC approval, purpose-bred hounds (n = 5) were humanely euthanized. Immediately following euthanasia, a penetrating captive bolt pistol with 1.25 grain cartridge centered on the cranial aspect of each distal humerus was discharged to create open fractures in 3 dogs (6 elbows). In 2 dogs, matched osteoarticular tissues from non-injured elbows (controls) were retrieved for comparison. Distal humerus, proximal radius, and proximal ulna osteoarticular fragments (n = 27) were immediately placed in Missouri Osteochondral Preservation System (MOPS) solution and stored at room temperature. Radiographic, chondrocyte viability, and quantitative microbial culture assessments were performed immediately (time-0) and at 7 and 14 days of storage. ResultsThis preclinical canine model reliably produced type 3 open distal humeral fractures characterized by devascularized and contaminated osteoarticular fracture fragments. All fragments produced extensive microbial growth through 14 days of storage. Without decontamination, viable chondrocyte density in the fragments decreased significantly within 7 days, likely attributable to the profound contamination. ConclusionThese data highlight the importance of developing a reliable method for point-of-care decontamination and preservation of osteoarticular fracture fragments for safe and effective reimplantation of articular fracture fragments for joint reconstruction.

Evaluation of functional outcome using dual plating in treatment of intraarticular distal humerus fractures in adults.

Of all the humerus fractures in adults, 30% are of the distal end of the bone. The dual plate is strong biomechanically. The current study was conducted at Al-Yarmouk Teaching Hospital, Baghdad, Iraq, between July 1, 2019 to July 1, 2021 to study the role of dual plating in intra-articular distal humerus fractures. Included were 20 adult patients, all with intra articular fracture of the distal humerus and treated and evaluated by open reduction and internal fixation technique using dual locking plating. Clinically the final results were assessed using the Mayo Elbow Performance Score (MEPS). The final results were observed to be excellent in 12 (60 %), good in 6 (30%), fair in 2 (10 %) patients, with no poor results recorded. One patient had transient ulnar neuropraxia which recovered spontaneously after six weeks and one patient developed superficial skin infection which responded to antibiotic treatment. The mean of MEPS was significantly higher after six months and one year than that after two weeks, two months, and four months of operation.

Surgical Treatment of the Frontal Plane Distal Humerus Fractures

The frontal plane fractures of the distal humerus are rare. The small intraarticular fragments, the commonly encountered osteoporosis and the specific anatomy make the successful osteosynthesis a challenge. For a period of 15 years in First Clinic of Orthopaedic Traumatology 27 patients with capitulotrochlear fractures were treated. Of them, 12 women and 3 men were followed. The fractures were classified after Dubberley as follows: Type 1А - 1, type 2А - 2, type 2В - 3, type 3А - 5, type 3В – 1, and type 4В - 3. A plethora of surgical exposures were used - extended lateral, paratricipital, a combination of medial and lateral, dorsal with olecranon osteotomy. Primary TEA was performed in 3 patients: Type 3A - 1, type 3В – 1, and type 4В - 1. The patients were followed for a period of 12 months to 8 years. The results were evaluated by the MEPS, DASH and McGowan scores. The final ROM, compared to the contralateral side, was recorded. The average scores are comparable with the ones in a number of publications in the referent literature. As evaluated by MEPS, excellent results were found in 53% of patients, good – in 27%, fair in 7%, and poor –in 13%. The most serious problem was the elbow stiffness. Early deep infection was found in 1 patient with type 4B fracture. Ectopic ossification Hastings type I was found in 1 patient. The modern surgical treatment is based on anatomical reduction through fracture type-specific surgical exposure and rigid osteosynthesis. The treatment of choice for irreparable fractures is total elbow arthroplasty (TEA). We discuss the fixation devises, the surgical exposures and the osteosynthesis construct. Our own osteosynthesis preferences are centered around the fixation in the frontal plane and the additional augmentation with sagittal plane implants.

Single-Plate versus Dual-Plate Utilization for Treatment of Humeral Shaft Fractures: A Retrospective Clinical Series

Objectives Dual plating is the current standard of care for displaced distal humerus fractures and even some metadiaphyseal humeral fractures. Single plate fixation is the current standard of care for humeral shaft fractures when performing open reduction and internal fixation (ORIF). A role may exist for dual plating of humeral shaft fractures. This study aims to compare clinical outcomes of single versus dual-plating when performing ORIF procedures on humeral shaft fractures. Methods A retrospective study of 143 patients (81 females, 62 males; mean age 47.3) who sustained humeral shaft fractures (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (OTA/AO) type 12A, B, and C) and received either dual or single plating via ORIF between March 2010 and May 2022. Of the 143 patients, 79 (55%) received single plating, while 64 (45%) received dual plating. To account for possible confounders, we collected data on patient characteristics, mechanism of injury, and intra-surgical variables. Primary outcome measurements compared radiographical x-ray imaging (3-months, 6-months, and 12-months), complications, and visual analog scale (VAS) score. Results There was no statistically significant difference between VAS scores, union rates, post operative radial nerve injury, infections, or hardware failure for primary surgical outcomes. Patients were allowed to bear weight as tolerated more quickly in the dual-plating group. An association was observed between the usage of dual plates and osteoporosis. Conclusion In conclusion, we found dual-plate fixation for ORIF of humerus fractures to be not statistically significantly different compared to single plate fixation. Dual-plating has satisfactory radiograph and clinical outcomes compared to conventional single-plate fixation. While we are not advocating for the routine use of dual-plating, the results of our study suggest that the use of dual-plating produces similar outcomes when compared to single-plating for ORIF of a humerus shaft fracture.

Functional Outcome of Perpendicular Plating Versus Parallel Plating In The Management Of Distal Humerus Fractures- A Comparative Study

Distal humerus fractures are quite uncommon but pose significant challenges in management due to their complex anatomy and varied fracture patterns. Surgical intervention, particularly using plate fixation, is often necessary to achieve stable fracture union and restore functional elbow mobility. This prospective comparative study aimed to analyse the outcomes of distal humeral fracture management using perpendicular and parallel plating techniques. Thirty patients with distal humeral fractures underwent osteosynthesis with either perpendicular or parallel plating between November 2020 and October 2022 at Saveetha Medical College and Hospital in Chennai. The Mayo Elbow Performance Score has been utilized to measure the following assessment parameters: pain, radiological, stiffness and clinical union, and functional elbow ability at 6 weeks, 3 months, 6 months, and 1 year after the surgery.Both techniques yielded satisfactory outcomes in terms of fracture union and functional recovery. However, complications and biomechanical properties differed significantly between the two methods. Parallel plating demonstrated superior stability and resistance to plastic deformation, particularly in osteoporotic bone, suggesting potential advantages in managing comminuted distal humerus fractures with an intraarticular component. This study contributes valuable insights into the optimal management strategies for distal humeral fractures and highlights the importance of considering individual patient factors and fracture characteristics when selecting the most suitable surgical approach. Additional investigation is necessary to verify these results and improve methods of treatment for this difficult kind of fracture.

Vitamin D status in healing of distal humeral fractures: Clinical observations.

Fracture healing is a complex biological process that begins soon after a fracture has occurred. Whereas the role of vitamin D status on the maintenance of bone health is well established, the clinical effects of vitamin D deficiency in the healing of distal humeral fractures are less well explored. This study examines the role of vitamin D serum levels in distal humeral fractures (C2, C3) managed with open reduction and double plate fixation, by comparing its concentration in patients with or without radiographic signs of fracture healing and in control subjects. Our hypothesis is that 6 months from treatment vitamin D levels will be different between the groups of patients. We measured the vitamin D serum level in a cohort of consecutive adult patients aged 30 to 60 years. They included a group of subjects without fractures who were admitted to our clinic in the 6 months preceding the study (controls) and two groups of patients with humeral fractures who at 6-month follow-up showed or failed to show radiological signs of fracture healing. The mean vitamin D concentration was 23.03 μg/L (±5.8) in the group with radiographic signs of fracture healing, 9.30 μg/L (±2.60) in the group with radiographic signs of delayed union and 26.15 μg/L (±11.76 μg/L) in the control group. Significantly different (p < 0.05) concentrations were measured between the fracture groups, between the group with radiographic signs of fracture healing and the control group and between the group with radiographic signs of delayed union and the control group. Vitamin D is primarily involved in the stages of hard callus formation and remodelling. It also has several functions that affect the early stages of fracture healing. Vitamin D influences the cellular process of bone healing, although the underlying mechanism is still partly unclear. It would be useful to determine the vitamin D status of fracture patients at admission and to start supplementation, with periodic checks, to foster the consolidation phase. Although vitamin D is clearly not the only factor influencing the consolidation of a surgically treated distal humerus fracture, its concentration can easily be determined and managed. Our data suggest that vitamin D levels should be determined at admission and that fracture patients with low concentrations should be started on vitamin D supplementation.

Study on morphometry of distal humerus and its clinical correlations.

Morphometric analysis of bones gives essential information for reconstructive surgeries and prosthetics. It is also useful in forensic medicine to identify and estimate age, sex and height from skeletal remains. We have measured and analyzed the following parameters in 100 distal humerii: the maximal length of the humerus, transverse distance between medial epicondyle and lateral epicondyle, horizontal diameter of trochlea, antero-posterior diameter of trochlea, and horizontal distance from medial epicondyle to capitulum. Distal humeral fractures are often challenging and difficult to treat which requires knowledge of distal humeral anatomy. Data from this study and the comparisons made will help in this.

Intra-operative subperiosteal elevation of the ulnar nerve is a safe and effective way to minimize post-operative ulnar neuritis in distal humerus fractures.

To describe subperiosteal elevation of the ulnar nerve and compare to anterior transposition and in situ decompression techniques. Design: Retrospective comparative study. Urban Level 1 trauma center. Distal humerus fractures (OTA/AO 13) treated with open reduction internal fixation between 2014-2022. Rate of pre- and post-operative neuritis grouped by management of the ulnar nerve. During subperiosteal elevation, the ulnar nerve was identified and raised off the ulna subperiosteally and mobilized submuscularly anterior to the medial epicondyle to protect the nerve. The nerve was released only laterally off the triceps and the medial soft tissue attachment is maintained. The main outcomes measurements was rate of neuritis documented within physical exam. Within the 125 patients, 35 underwent subperiosteal elevation (mean age of 56 ± 21 years, 57% female), 63 in situ decompression (mean age of 60 ± 18 years, 46% female), and 27 anterior transposition (mean age of 55 ± 20 years, 59% female). Pre-operative ulnar neuritis was present in 34%, 21%, and 33% of patients treated with subperiosteal elevation, in situ decompression, and anterior transposition, respectively (p=0.26). At post-operative evaluation symptom resolution occurred in 100%, 69%, and 33% of patients treated with subperiosteal elevation, in situ decompression, and anterior transposition, respectively (p=0.003). New cases of post-operative ulnar neuritis occurred in 6%, 8%, and 26% of patients treated with subperiosteal elevation, in situ decompression, and anterior transposition, respectively (p=0.054). Subperiosteal elevation outperformed anterior transposition regarding post-operative ulnar neuritis (p=0.019) and symptom resolution (p=0.002) and performed similarly to in situ decompression (p>0.05). On multiple regression analysis, anterior transposition was an independent risk factor for post-operative neuritis (OR=5.2, p=0.023). Subperiosteal elevation is an effective way to minimize post-operative neuritis and similar to an in-situ decompression during distal humerus fracture fixation. Based on the results of this cohort, authors recommended that anterior transposition of the ulnar nerve be used with caution due to association with post-operative ulnar neuritis. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Reconstructing a Lay Individual’s Elbow Fracture at Santa Caterina Friary, Barcelona (15th–16th Century): The Contribution of Paleopathology to the Valorization of Bioarcheological Heritage

The paleopathological literature notably lacks the description and analysis of distal humeral fractures and their associated complications. The objectives of this study were (1) to evaluate a distal humerus fracture associated with cubitus valgus observed in the articulated right elbow of an adult male buried in the Santa Caterina Friary site in Barcelona, dating back to the modern period (15th to early 16th century), and (2) to contribute to the valorization of bioarcheological heritage. Employing macroscopic and radiographic studies, the injury was assessed. The results indicated a healed antemortem fracture, probably associated with a fall. In the AO/OTA classification, it corresponds to type 13C1.1 (complete articular fracture, articular simple, metaphyseal simple, above the transcondylar axis), accompanied by a coronoid process fracture due to anterior trochlear dislocation impact (O’Driscoll type 1 classification: transverse fracture of the distal apophysis with involvement of the sublime tubercle). This fracture, resulting in a 28° cubitus valgus and significant elbow changes, infers community support in healing and highlights the socio-economic dynamics of guilds and adaptive strategies to physical adversities. This study is one of the first to describe cubitus valgus in a historical Spanish population, offering a comprehensive view of the complexities, physical adversities, and adaptive strategies employed by individuals following an elbow fracture.

Risk factors for dysfunctional elbow stiffness following operative fixation of distal humerus fractures

BackgroundElbow stiffness is one of the most common complications after operative fixation of distal humerus fractures; however, there is relatively limited literature assessing which factors are associated with this problem. The purpose of this study is to identify risk factors associated with dysfunctional elbow stiffness in distal humerus fractures after operative fixation. MethodsA retrospective review of all distal humerus fractures that underwent operative fixation (AO/OTA 13A-C) at a single level 1 trauma center from November 2014 to October 2021. A minimum six-month follow-up was required for inclusion or the outcome of interest. Dysfunctional elbow stiffness was defined as a flexion-extension arc of less than 100° at latest follow-up or any patient requiring surgical treatment for limited elbow range of motion. ResultsA total of 110 patients with distal humerus fractures were included in the study: 54 patients comprised the elbow stiffness group and 56 patients were in the control group. Average follow-up of 343 (59 to 2,079) days. Multiple logistic regression showed that orthogonal plate configuration (aOR: 5.70, 95% CI: 1.91-16.99, p=0.002), and longer operative time (aOR: 1.86, 95% CI: 1.11-3.10, p=0.017) were independently associated with an increased odds of elbow stiffness. OTA/AO 13A type fractures were significantly associated with a decreased odds of stiffness (aOR: 0.16, 95% CI: 0.03-0.80, p=0.026). Among 13C fractures, olecranon osteotomy (aOR: 5.48, 95% CI: 1.08-27.73, p=0.040) was also associated with an increased odds of elbow stiffness. There were no significant differences in injury mechanism, Gustilo-Anderson classification, reduction quality, days to surgery from admission, type of fixation, as well as rates of ipsilateral upper extremity fracture, neurovascular injury, nonunion, or infection between the two groups. ConclusionDysfunctional elbow stiffness was observed in 49.1% of patients who underwent operative fixation of distal humerus fractures in the present study. Orthogonal plate configuration, olecranon osteotomy, and longer operative time were associated with an increased odds of dysfunctional elbow stiffness; however, 13A type fractures were associated with decreased odds of stiffness. Patients with these injuries should be counseled on their risk of stiffness following surgery, and modifiable risk factors like plate positioning and performing an olecranon osteotomy should be considered by surgeons.

Primary Elbow Arthroplasty in the Management of Complex Distal Humerus Fractures.

Introduction Complex distal humerus fractures pose significant challenges in orthopedic surgery, especially when traditional open reduction and internal fixation (ORIF) is not feasible. Primary elbow arthroplasty has emerged as an alternative treatment option for these fractures, but its application remains limited. This study aimed to evaluate the functional outcomes, patient selection criteria, and follow-up results of primary elbow arthroplasty in the management of complex distal humerus fractures. Methods A retrospective review was conducted on 15 patients who underwent primary elbow arthroplasty for Orthopaedic Trauma Association (OTA) type C distal humerus fractures between 2017 and 2023 at our institution. Inclusion criteria were patients aged 18 years or older who were offered either total elbow or hemiarthroplasty for acute complex distal humerus fracture. Data were collected from patient medical records, including demographic information, fracture classification, surgical details, and postoperative follow-up. Functional outcomes were assessed using the Oxford Elbow Score (OES) and Mayo Elbow Performance Score (MEPS). Complications were documented, and descriptive statistics were used to summarise the findings. Results The mean age of the patients was 71.8 years (IQR 17 years), with 12 females and three males. The mean time to surgery was 14.7 days post-injury (IQR: 12 days). The mean follow-up duration was 52 weeks (range: 8-234 weeks, IQR: 27 weeks) and variability was noted. The mean flexion-extension arc at the final follow-up was 93° (IQR: 32.5°). The mean OES was 46 (IQR: 22), and the mean MEPS was 75 (IQR: 37), indicating good to excellent functional outcomes. Scores for two patients were not available due to dementia. Reported complications included one case of ulnar sensory symptoms and one case requiring metalwork removal following olecranon osteotomy. Conclusion Primary elbow arthroplasty provides a viable treatment option for complex distal humerus fractures, demonstrating significant functional improvements and high patient satisfaction. However, the variability in follow-up and subjective decision-making underscores the need for standardized protocols. Future multicenter, prospective studies with larger cohorts and standardized follow-up protocols are recommended to confirm these findings and optimize patient care.

Total elbow arthroplasty and hemiarthroplasty in the treatment of distal humerus fractures in the elderly: Experience from a tertiary referral centre

BackgroundThere is no clear consensus on whether total elbow arthroplasty (TEA) or hemiarthroplasty (HA) is superior for treating distal humerus fractures in the elderly. This study analysed the functional outcomes and re-operation rates following TEA and HA for intra-articular distal humerus fractures in patients aged ≥65 years. Methods19 patients (TEA = 12, HA = 7) treated between 2016 and 2022 were retrospectively reviewed. Mean age was 73 years and mean follow-up was 46 months. Functional outcomes and quality of life were assessed using the Mayo Elbow Performance Score (MEPS), Quick-DASH (Q-DASH), Oxford Elbow Score (OES), SF-12 Physical Component Score (PCS) and Mental Component Score (MCS), and EQ-5D. Complications requiring re-operation were recorded. ResultsHA showed superior outcomes in MEPS (93.6 vs 75.0, p = 0.0339), Q-DASH (13.3 vs 31.3, p = 0.0182), OES (41.7 vs 33.2, p = 0.0346), SF-12 PCS (55.5 vs 36.9, p = 0.0008) and EQ-5D (83 vs 67, p = 0.0023). One HA patient required revision to TEA for prosthetic joint infection. One TEA patient required revision for a periprosthetic ulna fracture. ConclusionHA provides better functional outcomes compared to TEA in the treatment of distal humerus fractures in the elderly. Data is limited by selection bias and low patient numbers with a multicentre randomised controlled trial warranted.

Nonunion of distal humeral fractures: Current concepts

The incidence of complex articular fractures of the distal humeral in adults has increased and will be growing in the future due to the greater incidence of high energy trauma and to the higher percentage of elderly population. Successful treatment is challenging for the needed balance between a stability of often comminuted fracture and early motion.Nonunion is a common complication after distal humerus fractures that is influenced by a variety of factors such as biology, in particular the blood supply of the metaphysis, the non-anatomical reduction of the fracture, the methods of fixation, and mechanical failure. These can involve the intra-articular or extra-articular areas. Clinical presentation may be mainly with a flail elbow in extra-articular nonunion or mainly with disfunction and stiffness for an intra-articular nonunion. However, the symptoms will depend on the degree of articular surfaces damage and the main localization of nonunion in the intra- and extra-articular region. The surgical treatment is usually required, being the non-operative treatment with a brace a reasonable option just for low-demand patients and with a high risk of complications. Despite a limited range of motion regained, the union rate achieved with internal fixation and bone grafting is substantially high.

Application of external fixator combined with Kirschner wire fixation for oblique and comminuted distal humeral metaphyseal-diaphyseal junction fractures in children

To analyze the effectiveness of external fixator combined with Kirschner wire (EF-KW) fixation in the treatment of oblique and comminuted distal humeral metaphyseal-diaphyseal junction (DHMDJ) fractures in children. A clinical data of 22 children with DHMDJ fractures who met the selection criteria between April 2021 and December 2023 was retrospectively analyzed. All patients were treated with EF-KW fixation. There were 14 boys and 8 girls with an average age of 6.8 years (range, 1.5-12.0 years). The time from injury to operation was 14-38 hours (mean, 24.2 hours). There were 18 cases of comminuted fractures and 4 cases of oblique fractures; and 1 case of median nerve injury and 1 case of radial nerve injury before operation. The occurrence of postoperative complications was recorded. At last follow-up, the function of the affected elbow joint was evaluated according to the Mayo elbow joint function score, and the Baumann's angle (BA) and humero-capitellar angle (HCA) of the affected and healthy sides were recorded and compared. All fractures were successfully treated with closed reduction and no complications such as nerve injury occurred. Superficial infection occurred in 4 cases after operation and healed after symptomatic treatment. The incisions of other patients healed by first intention. All patients were followed up 9-24 months (mean, 13.8 months). At last follow-up, according to the Mayo elbow joint function score, the elbow joint function was rated as excellent in 15 cases, good in 6 cases, and fair in 1 case, with an excellent and good rate of 95.5%. The neurologic injury before operation recovered gradually. X-ray films reexamination showed that all fractures healed, and the healing time of fractures ranged from 29 to 61 days, with an average of 35.6 days. At last follow-up, there was no significant difference in BA and HCA between the healthy side and the affected side ( P>0.05). During follow-up, 1 case developed mild cubitus varus, while the other patients had no serious complications. EF-KW fixation for oblique and comminuted DHMDJ fractures in children has the advantages of less trauma, simple operation, easy reduction, good stability after reduction, low incidence of serious complications, and good elbow functional recovery.

Clinical outcomes for linked fixation of distal humerus fractures: a multicenter study

BackgroundO’Driscoll popularized the principle of linked column fixation for distal humerus fractures. Despite the linked column concept being widely accepted, there are few reported techniques to accomplish this goal. A novel device was designed based on the principles of linked columns. An interlocking beam is used to connect the medial and lateral plates, creating a unified fixed angle construct. Our primary objective was to report clinical outcomes across multiple institutions for a linking beam used in distal humerus fracture fixation. MethodsA retrospective series was collected from five institutions for the TiBeam (Skeletal Dynamics, Miami, FL, USA) with a minimum follow-up of six months. Acute and chronic treatment of distal humerus fracture patterns, and all plate configurations were included for analysis. ResultsA total of 36 cases were collected at a mean age of 52 years and a mean follow-up of 19.3 months. AO C-type fractures were 56% of the series. The median MEPS was 85 (IQR 76.3 to 90), the median DASH was 21.4 (IQR 15.9 to 30), and the median VASa was 3.5 (IQR 2 to 5). An olecranon osteotomy was used in 86% of cases and an anatomic plate was used for fixation of the osteotomy in 94% of those cases. There were three cases of olecranon plate removal for a rate across the series of 13.7%. DiscussionOur short-term results demonstrate satisfactory clinical outcomes with low rates of revision for distal humerus fracture fixed with a linking beam. Further, the rate of removal for the olecranon osteotomy plate was lower than historical reports for aggregate methods of osteotomy fixation.