Distal Humerus Fractures Research Articles

Long-Term Functional Outcomes and Complications of Intra-Articular (AO type B, C) Distal Humerus Fractures in Adults: A Retrospective Review.

IntroductionTreatment of intra-articular fractures of the distal humerus is challenging due to their complexity, comminution, and associated complications. The evolution of surgical approaches and the design of elbow-specific implants over the last decades have failed to improve clinical and radiological outcomes. Studies are sparse regarding the long-term influence of surgical treatment of these types of fractures in the upper limb function. The purpose of the current study was to retrospectively review the long-term functional outcome and complications of all intraarticular (AO type B, C) distal humerus fractures treated surgically in a university hospital during the last 25 years.Material and methodsThe study included patients who were surgically treated for an intra-articular distal humerus fracture between March 1991 and May 2016. Our initial search, using ICD-10 codes, identified 63 patients in the specific time period. Twelve patients had died, nine declined to participate, eight had emigrated, nine could not be located and one patient was excluded as he suffered from quadriplegia unrelated to the initial injury. The remaining 25 patients (mean age at surgery 44.2±19.67) were included in a follow-up study protocol. Functional outcome was evaluated according to Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH). Pain was assessed using the Numerical Pain Rating Scale (NPRS) and subjects were asked to rate their satisfaction. Perioperative and late complications were recorded as well.ResultsThe average follow-up was 158.16 ± 73.73 months. The average score was 89.4 ± 12.36 for MEPS, 42.68 ± 4.03 for OES, and 8.1 ± 15.38 for the QuickDASH. The patient satisfaction was rated 3.8 ± 1.08 on average. The mean flexion of the affected elbow was 137.6 ± 12.68 degrees while extension deficit was present in 14/25 patients, with a mean of 8.6 ± 8.96 degrees. We did not observe any mal- or non-unions. The re-operation rate was 32% primarily due to stiffness and irritation from the hardware. We noticed one spontaneously resolved ulnar nerve palsy, one combined radial, and ulnar nerve palsy after extensive arthrolysis that also resolved two cases of heterotopic ossification, one case of implant failure, and two cases of infection - one superficial, which was managed with antibiotics, and the other was deep managed with surgical drainage.ConclusionsIn our series, we found a satisfying range of motion, good functional outcome, and adequate ability to perform daily activities at a very long follow-up. Posttraumatic arthritis, whenever present, does not seriously affect functional performance.Level of evidence: IV

Ultrasound-guided preoperative localization of radial nerve in the treatment of extra-articular distal humeral shaft fractures

BackgroundThe aim of this study was to discuss the treatment of extra-articular distal humeral shaft fractures using ultrasound-guided preoperative localization of radial nerve.MethodsBetween May 2010 and December 2019, 56 patients with extra-articular distal humeral shaft fractures were retrospectively reviewed. Twenty eight patients were received examination by using preoperative localization of radial nerve guided by ultrasound-guided preoperative localization (group A) and 28 control patients without ultrasound-guided (group B). All patients were treated surgically for distal humeral shaft fractures by posterior approach techniques. Operative time, radial nerve exposure time, intraoperative bleeding volume, union time and iatrogenic radial nerve palsy rate were compared between the two groups. Elbow function was also evaluated using the Mayo Elbow Performance Score (MEPS).ResultsA significant difference was observed between the two groups, Operative time (113.25 min vs 135.86 min) (P < 0.001), radial nerve exposure time (20.82 min vs 32.53 min) (P < 0.001), intraoperative bleeding volume (246.80 ml vs 335.52 ml) (P < 0.001). However, iatrogenic radial nerve palsy rate (3.6% vs 7.1%) (P = 0.129), the fracture union time (13.52 months vs 12.96 months) (P = 0.796) and the MEPS score (87.56 vs 86.38) (P = 0.594) were no significantly different in both groups.ConclusionsThe study demonstrates that ultrasound-guided preoperative localization is an effective approach in the treatment of extra-articular distal humeral shaft fracture by revealing radial nerve, which may help reduce the operative time, radial nerve exposure time and the intraoperative bleeding volume.

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.

Are Outcomes Comparable for Repair of AO/OTA Type 13C1 and Type 13C2 Distal Humeral Fractures Using the Paratricipital Approach?

BackgroundStudies have reported favorable outcomes using the paratricipital approach for fixation of distal humeral intra-articular fractures. However, literature evaluating the clinical results of the approach remains limited. The objective of this study was to compare clinical outcomes between type 13C2 and type 13C1 distal humeral fractures after open reduction and internal fixation performed using the same approach and same type of plate.MethodsA total of 52 adults with type 13C1 or 13C2 distal humeral fractures were treated surgically at our institution during 2006 to 2018. We retrospectively analyzed data from 29 of these patients (19 with type 13C1 fractures and 10 with 13C2 fractures) who met the inclusion criteria. All subjects were followed for a minimum of 2 years postoperatively. Clinical and radiologic results were analyzed to determine differences in outcomes between the two types of fractures. Clinical results were evaluated using elbow range of motion (ROM), Mayo Elbow Performance Score (MEPS), and Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score. Alignment, fracture union, and presence of posttraumatic arthritis were evaluated radiologically.ResultsThe patients’ mean age was 51 years, and the mean duration of follow-up was 29 months. Mean ROM was 129.5° ± 21.5° in the type 13C1 group and 123.0° ± 20.6° in the 13C2 group (p = 0.20). Mean Q-DASH score was 12.6 ± 11.7 in the 13C1 group and 16.2 ± 19.8 in the 13C2 group (p = 0.60). Mean MEPS was 92.9 ± 8.5 in the 13C1 group and 85.0 ± 14.1 in the 13C2 group (p = 0.09). Carrying angle did not differ significantly between the 13C1 and 13C2 groups. No patient in either group exhibited nonunion or posttraumatic arthritis.ConclusionsAlthough the paratricipital approach has the disadvantage of limited visualization of articular surfaces, there were no differences in surgical outcomes between type 13C1 and type 13C2 distal humeral fractures after fixation using this approach. Thus, surgeons may need to consider using the paratricipital approach for open reduction and internal fixation of 13C2 distal humeral fractures.

Standardized fracture creation in the distal humerus and the olecranon for surgical training and biomechanical testing

IntroductionSurgical training and biomechanical testing require models that realistically represent the in vivo injury condition. The aim of this work was to develop and test a method for the generation of distal humerus fractures and olecranon fractures in human specimens, while preserving the soft tissue envelope.MethodsTwenty-one cadaveric upper extremity specimens (7 female, 14 male) were used. Two different experimental setups were developed, one to generate distal humerus fractures and one to generate olecranon fractures. Specimens were placed in a material testing machine and fractured with a predefined displacement. The force required for fracturing and the corresponding displacement were recorded and the induced energy was derived of the force–displacement graphs. After fracturing, CT imaging was performed and fractures were classified according to the AO classification.ResultsEleven distal humerus fractures and 10 olecranon fractures with intact soft tissue envelope could be created. Distal humerus fractures were classified as AO type C (n = 9) and as type B (n = 2), all olecranon fractures were classified as AO type B (n = 10). Distal humerus fractures required significantly more load than olecranon fractures (6077 N ± 1583 vs 4136 N ± 2368, p = 0.038) and absorbed more energy until fracture than olecranon fractures (17.8 J ± 9.1 vs 11.7 J ± 7.6, p = 0.11), while the displacement at fracture was similar (5.8 mm ± 1.6 vs 5.9 mm ± 3.1, p = 0.89).ConclusionThe experimental setups are suitable for generating olecranon fractures and distal humerus fractures with intact soft tissue mantle for surgical training and biomechanical testing.

Functional outcome of distal humerus fracture in adults followed with bicolumnar fixation: A prospective study

Background: Distal humerus Fractures account for about 0.5 - 2% of all adult fractures, out of which a significant percentage (50 - 70%) of patients present with intraarticular and intercondylar involvement; thereby posing operative challenges to the surgeon. An attempt has been made in this study to evaluate the radiological and functional outcome of distal humerus fractures treated with bi columnar fixation. Materials and Methods: Our study consists of 20 posts traumatic distal humerus fracture AO type C operated at Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram between May 2019 and December 2021. The Mayo Elbow Performance Score was employed for the assessment of Functional Outcome. Patients were regularly followed up at the intervals of 6 weeks, 3 months, 6months and 1 year postoperatively. Results: There were 13 (65.0%) female patients, and 7 (35%) male patients over a wide age range of 18 years to 75 years. The mean age of these patients being 44.6 years. The majority had an involvement of the nondominant limb; left humerus 15 (75%) and the rest of the cases were right humerus 5 (25%). The fractures were stabilized with bicolumnar locking compression plates with Lag Screws depending on the fracture pattern. The final follow-up majority showed good to excellent outcomes with the mean arc of elbow flexion of 116 degrees, average extension deficit of 7 degrees, average supination of 70 degrees, and average pronation of 70 degrees. Conclusions: Olecranon Osteotomy approach gave a better visualization of the fracture site and an easier articular reconstruction opportunity. Bicolumnar fixation showed good outcomes and achieved satisfactory union rates.

Distal humerus extraarticular fractures with large butterfly fragment: How we deal with it

Background: The treatment of distal-third extra-articular fracture of the humerus with large butterfly fragment is challenging and often controversial. The aim of this study is to see the result of open reduction and internal fixation of such fractures fixed with pre-contoured extra-articular anatomical locking plate in context to percentage of union, time of union and functional capability. Materials and Methods: This is a prospective study comprising of 28 cases from 2016 to 2019 with average follow-up of 19 months. In this study, all the cases included were extra-articular fractures of distal humerus having large butterfly fragments and were comminuted. The simple distal humeral extra-articular fractures without comminution were excluded from study. All the patients were operated on with posterior triceps reflecting approach and fixing the fractures with 3.5 mm pre-contoured extra-articular locking plate. Results: Out of 28 cases, there were 17 males and 11 females with mean age of 34.8 years. 4 patients were having post injury radial nerve palsy. None of the patients in our series were treated conservatively. The average time of operation after injury was 7 days and the average time of union was 20 weeks. 3 of the patients post operatively developed radial nerve palsy which completely recovered within 5 months. The results were evaluated with Mayo elbow performance score. Conclusion: Distal humeral comminuted extra-articular fractures are complex and difficult to manage. A pre-contoured distal humeral plate is a good option and gives adequate purchase for distal fixation. Moreover, the triceps sparing approach is good and chances of nerve injury and stiffness are less. We are happy with this plate and type of fixation.

Functional outcome of internal fixation of complex intraarticular fractures of the distal humerus (OTA-AO type-C) in focus of O’Driscoll criteria for optimized stability

Introduction Internal fixation of distal humeral fractures is challenging because of complex anatomy and articular or metaphyseal comminution. Bi-columnar locked plating (orthogonal or parallel) is the standard method of fixation the success of which requires a rigid stable construct to optimize stability. The aim of this retrospective study was to evaluate the outcome of fixation of type-C distal humeral fractures by orthogonal locked plates and to determine the causes of early mechanical failure according to O’Driscoll criteria of optimized fixation stability. Settings and design A retrospective study conducted in Benha University Hospital. Patients and methods A review of 34 patients with type-C distal humeral fractures fixed with orthogonal anatomical locking plates through the period from 2014 to 2019, and evaluation of their outcome after 24–36 months. Radiographic images were reviewed for O’Driscoll criteria of optimized fixation, and complications were recorded. Results Functional outcome was assessed with Mayo elbow performance score. Twenty patients had an excellent outcome, seven patients good and seven fair in whom, O’Driscoll criteria for optimized fixation stability were not met and fixation was revised. All patients showed radiological union of fractures after about 3 months from definitive fixation. Multivariate analysis of the collected data was done by SPSS software to determine the cumulative percent of its factors and its relation with the final outcome. Conclusion Internal fixation of type-C distal humeral fractures by anatomically precontoured locking plates must be optimized according to O’Driscoll criteria to avoid early mechanical failure, revision surgery, and to achieve satisfactory functional outcome.

The Usefulness of Elbow Arthrography in Distal Humeral Fractures in Children

The Usefulness of Elbow Arthrography in Distal Humeral Fractures in Children

Evaluation of outcome of distal humerus fracture fixation by two-locked plates

Objective: The objective of the study was to evaluate the results of operative management of distal humerus fracture fixation by two-locked plates. Materials and method: This was a retrospective study involving 72 patients with distal humeral fractures who were managed surgically by fixation with two-locked parallel plates at Al- Gamhoria Teaching Hospital, and two private hospitals, in Aden, Yemen, between January 2018 and December 2020. The data was entered into a computer and analyzed using SPSS program version 17. For variables difference, chi-square tests, and P values were calculated. A p- value of &lt; 0.05 was considered statistically significant. Results: The total study patients were 72 and they were (79.2%) males and (20.8%) with a ratio of male to female of 3.8:1. The mean age of the patients was 37.8 ± 15.3 years and the age ranged between 11 and 75 years. Most of the patients (69.4%) were of age 40 years, while more than 40 years old represented (30.6%). Causes of fractures were gunshots (56.9%) followed by road traffic accidents (37.5%). Left side was predominant with (62.5%). Type of injuries were open with (73.6%) and closed with (26.4%). Partially articular fractures were in (86.1%) of cases and complete articular fractures were in (13.9%) cases. Transpositions of ulnar nerve were found in (65.3%) cases. Ulnar nerve neuropraxia was found in (5.6%) cases and the Range of Motion (ROM) was limited (pron. – sup 30-45/flex – exten 30 – 130) in (29.2%) cases and no range of motion in (9.7%) cases. Non-union was found in (4.2%) cases while superficial infection was in (5.6%) cases. Stiffness was found in (9.7%) cases. Conclusion: This study revealed that managing the distal humeral fractures by internal fixation of two Parallel-Plates gives satisfactory results. Key words: distal humerus, fracture, internal fixation, locking plate, outcome

In situ placement of ulnar nerve in distal humerus fractures with bicolumnar fixation and post operative incidence of ulnar neuropathy: A retrospective study

In situ placement of ulnar nerve in distal humerus fractures with bicolumnar fixation and post operative incidence of ulnar neuropathy: A retrospective study

The relationship between extremity fractures and visual impairment in childhood: A case-control study.

Fractures are common extremity injuries in pediatric orthopedic practice. The aim of this study is to determine the relationship between pediatric extremity fractures and visual impairments. Thirty pediatric patients who were admitted to the emergency and orthopedics and traumatology clinic due to an extremity fracture after a fall were included in the study. Following fracture treatment, the patients were evaluated in terms of ocu-lar findings before discharge from the hospital. Thirty age- and sex-matched healthy children who presented to the ophthalmology department for routine care were also recruited as the control group. All participants underwent a comprehensive ophthalmologic examination, including cycloplegic refraction, visual acuity levels, and near stereoacuity measurement. The number of male participants was higher in both groups. There was no significant difference between the groups in terms of age and gender distribution. The most common upper extremity fractures were observed to be distal radius (52%) and distal humerus fractures (28%). The number of patients who had a refractive error that required spectacles was significantly higher in the fracture group (p=0.039). When the visual acuity levels of the better eye were evaluated, the mean visual acuity was significantly lower in the fracture group (p=0.016). The mean stereoacuity was also significantly lower in the study group (<0.001). In the binary logistic regression analysis model, low stereopsis levels were associated with the risk of pediatric extremity fractures (95% CI: 1.056-1.385; p=0.006). Our study showed that low-energy pediatric extremity fractures are more common in children with visual im-pairments that require treatment, and low stereopsis is a risk factor for fractures. Consequently, regular eye examinations and early treatment of visual impairments in children may help to prevent fall-related injuries.

Triceps-off transfascial sleeve approach, functional outcomes and surgical technique in distal humerus fractures

BACKGROUND: We aimed to assess functional and clinical outcomes of patients who underwent open reduction and internal fixation of distal intra-articular fractures of the humerus through a previously undescribed approach through the triceps tendon, called the triceps-off, transfascial sleeve (TOFS) approach METHODS: We conducted an ambispective cohort study of ten patients who underwent open reduction and internal fixation of the distal humerus through the TOFS approach at a tertiary hospital between March 2016 and January 2019. Patients were identified from the prospectively kept surgical database. All had AO type C fractures of the distal humerus. The mean age was 36.7 ± 14.9 years (range 19-68). The assessment consisted of a review of their hospital records, range of motion, triceps strength, ultrasound evaluation of triceps tendon integrity, X-rays for union rates and adequacy of reduction, and DASH scores RESULTS: The mean time of follow-up was 10.8 ± 4.7 months (range 6-19). The mean arc of motion was 114.7 ± 25.1 degrees (range 80-150). There was a decrease in mean triceps muscle strength compared to the uninjured side: 66% at 45° of flexion, 70% at 90° and 86% at 120° of elbow flexion. The mean DASH score was 15.7 ± 8.9, indicating mild residual impairment (range 5-31). The DASH score had a strong correlation (r = 0.71; p &lt; 0.05) with the follow-up period. All tendons were intact on ultrasound evaluation. One patient had deep surgical site infection, treated with surgical debridement, antibiotics and plate removal with resolution of sepsis and healing. All fractures united by six months CONCLUSION: TOFS is a successful surgical approach for reduction and fixation of AO type C intra-articular distal humerus fractures, with excellent tendon healing rates. It is, however, associated with mild residual functional impairment and residual triceps weakness Level of evidence: Level 4

Buried vs. Exposed K-wire Fixation in Lateral Condyle Distal Humerus Fractures in Children

Introduction: Distal humerus lateral condyle fractures are common injuries in childhood and need effective treatment to prevent complications. Open reduction and internal fixation with Kirschner (K) wires is a proven, cost-effective and convenient technique for treating pediatric lateral condyle distal humeral fractures. K-wires may be buried beneath the skin or inserted through the skin with the wire ends exposed. There is no clear consensus as to whether K-wires should be buried or left exposed outside the skin. The aim of this study to compare the results and complications of divergent buried and non-buried K-wires in the treatment of lateral condyle fractures of the distal humerus. Methods: A study was conducted between March 2019 to August 2020 in 32 pediatric patients with lateral condyle fractures of distal humerus who were treated with open reduction with divergent k-wire fixation in our hospital. All patients under the age of 14 years presenting with lateral condyle humerus fractures with more than 2 mm displacement were included in the study. The exclusion criteria were open fractures, undisplaced fractures treated conservatively, and pathological fractures. Results: 32 patients under the age of 14 years were included in this study and were divided into two groups (Buried K-wire group and Exposed K-wire group) based on the treatment they received. Out of the 16 cases with exposed wires, 2 cases had superficial pin tract infection. And out of 16 cases with buried wires, 3 cases developed an infection, and 5 cases had skin erosion. However, no case of severe infection was seen. No cases of non-union were seen and all patients returned to preinjury function.

Good functional outcomes after open reduction and internal fixation for AO/OTA type 13-C2 and-C3 acute distal humeral fractures in patients aged over 45 years.

The purpose of this study was to report the functional outcomes and complications after open reduction and internal fixation (ORIF) for Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) type 13-C2 and -C3 acute distal humeral fractures with minimum 2-year follow-up. Our hypothesis was that ORIF would provide functional outcomes that are comparable to those of total elbow arthroplasty and elbow hemiarthroplasty reported in the literature. During a 6-year period, 23 patients aged > 45 years were treated with double plating for AO/OTA type 13-C2 or -C3 fractures. The mean age was 62 years (range, 46-80 years). The Oxford Elbow Score was used as the primary outcome; the Mayo Elbow Performance Score, pain severity score (on a visual analog scale), range of motion, reoperations, and complications were used as secondary outcomes. The median Oxford Elbow Score was 42 (range, 25-48), where a score of 48 represents a normal elbow; 20 patients achieved good to excellent outcomes, and 3 achieved fair outcomes. The median Mayo Elbow Performance Score was 85 (range, 60-100), where a score of 100 represents a normal elbow; 18 patients achieved good to excellent outcomes, and 5 achieved fair outcomes. The median visual analog scale score was 2 (range, 0-5). The median flexion-extension and supination-pronation arcs were 120° (range, 70°-155°) and 160° (range, 75°-170°), respectively. Eight complications were recorded in 7 patients; 4 of them required reoperation because of fracture pseudarthrosis or elbow stiffness. Ten patients were working at the time of trauma, and nine of them returned to the same occupation. Our results are comparable to the results of previously published studies regarding the outcome of ORIF, elbow hemiarthroplasty, or total elbow arthroplasty for AO/OTA type 13-C fractures. ORIF is a reliable treatment option for AO/OTA type 13-C2 and -C3 acute distal humeral fractures in middle-aged and elderly patients, despite the considerable rate of complications. Good to excellent results can be obtained in most patients.

Surgical treatment of distal humeral fractures in the elderly using A.L.P.S. elbow plating system

Surgical treatment of distal humeral fractures in the elderly using A.L.P.S. elbow plating system

A NEW ANATOMICAL PLATE FOR EXTRA-ARTICULAR DISTAL HUMERAL FRACTURES: BIOMECHANICAL STUDY.

ABSTRACTIntroduction We compared the mechanical properties of two fixation techniques for the treatment of extra-articular distal third humeral fractures.Materials and Methods Two groups were created from twenty-four humeri. Group 1 was instrumented using a new, precontoured, 8-hole (3.5-mm-diameter) locking compression plate (LCP) placed anterolaterally. Group 2 was instrumented using an 8-hole (3.5-mm-diameter) precontoured posterolateral LCP plate placed on the distal humerus. Four-point bending tests and torsion tests were performed until the specimens broke.Results The four-point bending stiffness test showed that the stiffness of anterolaterally fixed humeri was significantly higher than that of posterolaterally fixed humeri (p<0.05). Torsion testing revealed that posterolateral fixation was associated with better yield strength (p<0.05), but the torsional stiffness did not differ significantly between the two plates (p> 0.05).Conclusions The anterolateral plate exhibited higher bending stiffness and torsional yield strength than the posterolateral plate. Anterolateral plate fixation can thus be used to manage extra-articular distal humeral fractures. Multiaxial locking screws ensure rigid fixation, allow early elbow motion without olecranon fossa impingement, and prevent iatrogenic injury of the triceps muscle. Level of Evidence I, Therapeutic Studies Investigating the Results of Treatment.

2 Cases of Radial Nerve Injury After Distal Humerus Fracture Treated by Superficial Branch Graft

2 Cases of Radial Nerve Injury After Distal Humerus Fracture Treated by Superficial Branch Graft

Low-Cost Method for Fixation of Distal Humerus Fracture in Elderly Osteoporotic Individuals: Experience from a Resource-Limited, Tertiary-Care Setting in North India

Introduction: About 7% of adult fractures involve elbow and around 2% involve distal humerus. Conventionally, these are managed by ORIF with plates and screws. Often osteoporosis and communition of fracture fragments is observed in elderly presenting with this pattern of injury. This further complicates the situation for reconstruction and stable fixation which is critical for early mobilisation. We present our fixation method of Joshi’s External Stabilizing System resulting in satisfactory outcome Methods: During study period (August 2017-Oct 2019), total of 19 patients (male=8) were treated at Dr Rajendra Government Medical College, Tanda, Himachal Pradesh, India. Seventeen of them were elderly osteoporotic individuals. Closed reduction was achieved in 7 cases who had displaced supracondylar humerus fracture. Open reduction through triceps splitting approach extending longitudinally up to fascial sleeve of forearm was done in one case of one year old neglected supracondylar humerus fracture and all cases of intercondylar humerus fracture (N=9). Articular visualisation and reduction were achieved after flexing to about 110 degrees and applying longitudinal traction through trochlear notch with the help of ribbon gauge, obviating the need of olecranon osteotomy. Results: Union was achieved in 15 cases; one case was lost to follow-up after 8 weeks. Another case is within 4 weeks follow-up. Elbow movements were initiated on first post-operative day in all. Fracture was classified on basis of A.O classification. Mayo elbow performance score system was done to evaluate the final functional outcome (Table 1). Conclusion: Complications encountered include minor pin-tract infections in 6 patients. In one patient, fracture was noted on 5th post-operative day at proximal level of construct. This was the patient with one year old neglected supracondylar humerus fracture. One patient was lost to follow-up. Others are doing well after a follow-up duration of 218 patient-months.

Surgical result of distal humerus fractures in adults: A consecutive series of 55 cases and review of the literature

Introduction: Fractures of the humeral pallet are more and more frequent; this is linked to the increase in road accidents and their violence. Methods: We have collected in our archives 55 cases of fracture of the humeral pallet at the Traumatology–Orthopedics Department of the IBN SINA CHU in RABAT from January 2015 to December 2019. Results: They mainly affect young adults with a clear predominance of men (73%). The trauma most often occurs by direct mechanism (65%). The main cause of these fractures is represented by road accidents (56%), followed by assaults and falls. Supra and intercondylar fractures are the most described anatomical form (65%). The treatment is surgical in all cases, with predominance of the posterior approach. Discussion: Considering the comminution often encountered, only a solid and stable osteosynthesis allows the anatomical restoration of the elbow, by adapting the indications to the types of fractures and by using a more codified technique, to allow an early rehabilitation, better guarantee of recovery of elbow function. The LECESTRE premolded plate is the most used in supra and intercondylar fractures; it seems to be a real progress in osteosynthesis (31.03% good results and 51.72% average results) for this type of fracture. Conclusion: The management of humeral paddle fractures is based on perfect anatomical reduction, by a solid assembly which must allow early rehabilitation ensuring good functionality. Level of Evidence: IV-retrospective study.