Extra-articular Distal Humerus Fractures Research Articles

Biomechanical Design Optimization of Distal Humerus Fracture Plates: A Review.

The goal of this article was to review studies on distal humerus fracture plates (DHFPs) to understand the biomechanical influence of systematically changing the plate or screw variables. The problem is that DHFPs are commonly used surgically, although complications can still occur, and it is unclear if implant configurations are always optimized using biomechanical criteria. A systematic search of the PubMed database was conducted to identify English-language biomechanical optimization studies of DHFPs that parametrically altered plate and/or screw variables to analyze their influence on engineering performance. Intraarticular and extraarticular fracture (EAF) data were separated and organized under commonly used biomechanical outcome metrics. The results identified 52 eligible DHFP studies, which evaluated various plate and screw variables. The most common plate variables evaluated were geometry, hole type, number, and position. Fewer studies assessed screw variables, with number and angle being the most common. However, no studies examined nonmetallic materials for plates or screws, which may be of interest in future research. Also, articles used various combinations of biomechanical outcome metrics, such as interfragmentary fracture motion, bone, plate, or screw stress, number of loading cycles to failure, and overall stiffness (Os) or failure strength (Fs). However, no study evaluated the bone stress under the plate to examine bone "stress shielding," which may impact bone health clinically. Surgeons treating intraarticular and extraarticular distal humerus fractures should seriously consider two precontoured, long, thick, locked, and parallel plates that are secured by long, thick, and plate-to-plate screws that are located at staggered levels along the proximal parts of the plates, as well as an extra transfracture plate screw. Also, research engineers could improve new studies by perusing recommendations in future work (e.g., studying alternative nonmetallic materials or "stress shielding"), clinical ramifications (e.g., benefits of locked plates), and study quality (e.g., experimental validation of computational studies).

Extra-Articular Distal Humerus Plate 3D Model Creation by Using the Method of Anatomical Features.

Proper fixation techniques are crucial in orthopedic surgery for the treatment of various medical conditions. Fractures of the distal humerus can occur due to either high-energy trauma with skin rupture or low-energy trauma in osteoporotic bone. The recommended surgical approach for treating these extra-articular distal humerus fractures involves performing an open reduction and internal fixation procedure using plate implants. This surgical intervention plays a crucial role in enhancing patient recovery and minimizing soft tissue complications. Dynamic Compression Plates (DCPs) and Locking Compression Plates (LCPs) are commonly used for bone fixation, with LCP extra-articular distal humerus plates being the preferred choice for extra-articular fractures. These fixation systems have anatomically shaped designs that provide angular stability to the bone. However, depending on the shape and position of the bone fracture, additional plate bending may be required during surgery. This can pose challenges such as increased surgery time and the risk of incorrect plate shaping. To enhance the accuracy of plate placement, the study introduces the Method of Anatomical Features (MAF) in conjunction with the Characteristic Product Features methodology (CPF). The utilization of the MAF enables the development of a parametric model for the contact surface between the plate and the humerus. This model is created using specialized Referential Geometrical Entities (RGEs), Constitutive Geometrical Entities (CGEs), and Regions of Interest (ROI) that are specific to the human humerus bone. By utilizing this anatomically tailored contact surface model, the standard plate model can be customized (bent) to precisely conform to the distinct shape of the patient's humerus bone during the pre-operative planning phase. Alternatively, the newly designed model can be fabricated using a specific manufacturing technology. This approach aims to improve geometrical accuracy of plate fixation, thus optimizing surgical outcomes and patient recovery.

Biomechanical analysis of a novel Y-plate designed for the treatment of extraarticular distal humerus fractures

Adult distal humerus fractures are infrequent, yet they account for one-third of all humerus fractures. For the treatment of comminuted and osteoporotic fractures, locking plates are claimed to be biomechanically superior to alternative internal fixing techniques. Treatment remains difficult despite recent advancements and the use of locking plates due to frequent comminution, low bone quality, and limited healing ability in osteoporotic bone. An optimal design of the newly constructed plate and the control model were selected. The biomechanical characteristics of non-osteoporotic and osteoporotic synthetic bone were compared on six models. The biomechanical properties of the new plate were tested and compared on 54 osteoporotic synthetic humerus models. The control models were reconstructive and parallel LCPs. The tests were carried out under static and dynamic axial, lateral and bending loads. Fracture displacements were measured by optical measuring system Aramis. The test model is significantly stiffer for lateral load (p = 0.0007) and for bending load at the moment of model failure (p = 0.0002), while for axial load the LCP model showed greater stiffness (p = 0.0017). During lateral dynamic loading, all three LCP models broke and there was a significant difference compared to the test model (p = 0.0125). The LCP model is dynamically significantly more durable under axial load, while the largest displacements were recorded with the test model (p = 0.029). The displacements induced by all three loads are within the limits that fulfil the parameters of appropriate biomechanical stability. A novel locking plate for extra-articular distal humerus fractures may provide an alternative to the traditional two-plate.

To evaluate the outcome of posterolateral plate in distal humerus fracture

Abstract Background: Extra-articular distal humerus fracture accounts for approximately 16% of humerus fractures and 3% of all fractures in adults. There is good evidence that the overall incidence of distal humerus fractures is increasing worldwide. There is a bimodal distribution concerning age and gender, with peaks of incidence in males aged 12–30 years and females aged 60 years and over. Fractures of the distal third of the humerus are challenging injuries due to their peri-articular location, the small size of the distal bone fragments, and the osteopenic quality of the bone in older adults. In this era of modern orthopedics, despite various advances, distal humeral fractures remain one of the most challenging injuries to treat. Extraarticular fractures of the distal humerus occur at an anatomical watershed between the humerus shaft and the intercondylar region. These injuries are often displaced and have complex fracture patterns with associated comminution. The aim of our study is to evaluate the outcome of the posterolateral plate in distal humerus fracture. Materials and Methods: This prospective study will be hospital based, and will be conducted at our center from September 2021 to May 2023. Patients will be selected from the emergency and outpatient departments of our college. Assessment of functional status will be done using Mayo Elbow Performance Score at 6 months postoperatively. Assessment and analysis of any complications were done in terms of loss of reduction, problems of union, and implant failure. Results: Out of 35 operated patients only 30 qualified to be included in this study. Patient demographics, mode of injury, side involved, soft tissue status, pre-operative radial nerve status, AO type of the fracture, associated injuries, and the time interval between injury and surgical intervention were recorded. During follow-up, the course of fracture healing will be documented radiologically (with a minimum of 6 weeks between successive radiographs). Evaluation of any possible loss of reduction that might occur, compared with the immediate post of radiographs. Assessment of functional status will be done using Mayo Elbow Performance Score at 6 months postoperatively. Radiological misalignment, especially varus deformities followed by apex posterior angulations was the most common deformity, though not clinically evident. Surgical fixation carries the advantage of restoration and maintenance of alignment of the fracture fragments and quick return of function. However, surgical fixation is plagued with complications like non-union, radial nerve palsy, infection, and hardware symptoms. Conclusion: In summary, treating extraarticular distal humeral fractures with plate osteosynthesis is often challenging because of the risk of centrally located posterior plates impinging on the olecranon fossa limiting distal inadequate fixation and leading to loss of fixation many times. The use of these posterolateral locking compression plate obviates this problem. The distal aspect of the plate contour around the lateral column allows for the insertion of up to five locking screws into the distal fragment. Out of 35 patients, 30 patients had complete follow-up, and only two patients needed revision of plating and bone grafting.

Risk factors for hardware-related complications after extra-articular distal humerus fracture fixation using an anatomical locking plate.

We aimed to identify the incidence and risk factors of hardware-related complications in patients treated with anatomical locking plate fixation for extra-articular distal humerus fractures. From 2013 to 2020, patients with extra-articular distal humerus fractures who underwent open reduction and internal fixation with an extra-articular distal humerus locking plate (EADHP) were retrospectively reviewed and categorized according to the presence/absence of hardware-related complications. Hardware-related complications were defined as the occurrence of skin prominence on the plate and discomfort in activities of daily living. Patient demographics, the lateral condylar angle, lateral body length, shaft-condylar angle of the humerus, and plate length were analyzed. Of the 29 patients, 10 (34%) did not develop hardware-related complications (group A), whereas 19 (66%) did (group B). Patient demographics did not differ between the groups. However, the number of patients who underwent hardware removal was significantly greater in group B (16/19) than in group A (4/10; p = 0.032). Radiologic assessment revealed no significant difference in the lateral condylar or shaft-condylar angle. However, the lateral body length was greater in group A than in group B (44.5 ± 4.8 vs. 39.5 ± 3.7, p = 0.007). The plate length significantly differed between the groups. Twelve of 19 (63%) patients in group B received short-hole plates (six holes), while nine of ten (90%) patients in group A received long-hole plates (eight holes). In the multivariable analysis, the lateral body length of the distal humerus (p = 0.047, odds ratio = 0.734, 95% confidence interval: 0.542-0.996) and plate length (p = 0.036, odds ratio = 0.076, 95% confidence interval: 0.542-0.996) were associated with hardware-related complications. Most patients developed hardware-related complications, particularly with short plates, mainly because of the narrow lateral body length of the distal humerus. Surgeons should be careful to secure EADHP in the appropriate position, especially when short plates are used in patients with narrow lateral body length.

Comparative study of a Y- anatomical and innovative locking plate versus double plate for supracondylar humeral fracture

IntroductionThere is no “gold standard” for the type of plate to be used for distal extra-articular humeral fractures; the most used is plating of each column. The objective was to evaluate the short-term clinical and radiological results of a Y- anatomical and innovative locking plate (YALP). HypothesisThe hypothesis is: this anatomical and innovative locking plate will produce satisfactory and reliable results on extra-articular distal humerus fracture superior to double plate fixation. Materials and methodsIn a retrospective observational multicenter study, all patients with a distal humerus fracture type 13 A2.2 according to AO classification fixed with a new Y-plate (YALP) were compared to the results of double plate fixation for the same type of fracture. With a follow-up of more than 12 months, the objective and subjective clinical elbow criteria as well as the overall function of the upper limb and radiological assessment were collected. ResultsWith an average follow up of 24±11 months, 26 patients met the inclusion criteria and received a YALP and 24 patients received double plate. All patients whose fracture had healed except one were pain-free (mean VAS 0.3±0.6). All patients had good subjective results (mean SEV 96%±4). Elbow function was excellent (mean total MEPS 96±4) with normal triceps strength (23/24 patients had a triceps strength graded 5/5 and one patient 4/5) and range of motion (flexion 139±8, extension −7±8 and pronosupination greater than 155 degrees). The operating time was shorter in the YALP group (84 ± 23minutes versus 97 ± 28minutes, p=0.03). The double plate group had more complications; the overall complication rate was significantly higher (p=0.02) in the double 90-degree plate group (12/24, 50%) with four nonunions, four symptomatic ulnar nerves, three hardware removals for pain and one radial nerve injury versus 5/26 complications (19%, p=0.02) in the Y-plate group: one iliac graft for nonunion, 1 plate removal due to functional discomfort, 1 twisted YALP, 1 broke interfragmentary screw and one symptomatic ulnar nerve. DASH, SEV, MEPS scores and flexion-extension range were better in the YALP group. DiscussionYALP produces satisfactory results in supracondylar fractures of the distal humerus. The results of YALP appear to be better than the results with two 90° plates for the same fracture type with a shorter operative time and easier management of fractures with proximal diaphyseal extension. Level of evidenceIII; case control study.

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.

Radiological and functional outcome of open reduction and internal fixation of extra articular distal humerus fracture using anatomical plate

Radiological and functional outcome of open reduction and internal fixation of extra articular distal humerus fracture using anatomical plate

Study of use of Uni-condylar locking plate in extraarticular distal humeral shaft fractures in adults

Objective: The purpose of this study was to evaluate the clinical and functional outcome of Uni-condylar Locking Compression Plating for Extra-articular Distal Humeral Shaft Fractures in adults and comparison with other techniques for management of extra-articular distal humerus fractures. Methods: This Prospective Study was carried out in the Department of Orthopaedics in Shadan Institute of Medical Sciences, Teaching Hospital and Research Centre, Hyderabad, Telangana during July 2018 to January 2021. Patient selection was based on Inclusion and Exclusioncriteria.20 patients with extra-articular distal humeral shaft fractures were treated with Uni-condylar Locking Compression Plating. The patient was placed, either in the lateral decubitus position with shoulder at 90 degrees of abduction and flexion and the elbow at 90 degrees of flexion, or fully prone position over bolsters. Through triceps sparing posterolateral approach, Unicondylar Locking Compression Plating was done. Assisted exercises and physiotherapy were started as early as possible. The functional outcome was evaluated using The Rating System of Cassebaum, for time taken for fracture union, complications and compared with other techniques of fixation.Results: All fractures in this study healed well within a period of 22 to 24weeks with a mean average of 16.1 weeks without any implant related complications. Only 1 patient showed delayed fracture union at 32 weeks and 1 patient developed superficial wound infection which resolved subsequently with use of antibiotics. The overall outcome of this study ranged between Fair and Excellent.Conclusion: This study has yielded excellent results and it shows that Uni-condylar Locking Compression Plating (LCP) is an excellent technique for internal fixation of extra-articular distal humeral shaft fractures, as it promotes high rate of early fracture union without any implant related and other complications.

Functional and Radiological Outcome in Distal Third Humerus Fracture Treated with Extra-articular Locking Plate: A Multicentric Retrospective Study.

Introduction:The optimal method for fixation of extra-articular distal humerus fractures poses a management dilemma. Although various plate configurations have been proposed, anatomic shaped extra-articular distal humerus locking plates (EADHPs) have emerged as a viable solution for these complex injuries. We assessed functional and radiologic outcomes in our retrospective case series of extra-articular distal humerus fractures managed with these plates at different centers in Cuttack, Odisha.Materials and Methods:One hundred and ten patients of extra-articular distal humerus fractures, who were operated at various trauma centers between January 2012 and December 2020, were identified. After exclusion, 100 patients were available for the final assessment. All patients were operated with the triceps-reflecting modified posterior approach. Regular functional–radiologic follow-up was done evaluating elbow functionality, fracture union, secondary displacement, nonunion, implant failure, and any complications; Mayo Elbow Performance Score (MEPS) was used for the final functional assessment.Results:Sixty-seven percent of male and 33% of female patients constituted the study group, who had an average follow-up of 18 months. Preoperatively three patients and postoperatively one patient had radial nerve palsy; all had neurapraxia and recovered completely. Overall, 95% of patients were adjudged to have complete radiological union within 3 months; 6% of patients developed nonunion. The mean flexion achieved was 123 + 22, and the mean extension was 4.031 + 6.50; five patients with head injury developed flexion deformity of 45. The average MEPS at the final follow-up was 91 + 9.8.Conclusion:Stable reconstruction and early initiation of physiotherapy are utilitarian to envision optimal outcome; the use of precontoured EADHPs has yielded satisfactory results with minimal complications in our hands.

Locking versus non-locking plates in fixation of extra-articular distal humerus fracture: a randomized controlled study.

Studies have shown that the use of nonlocking (reconstruction) plates in fixing distal humerus fractures may not yield stable fixation whichtherefore requires long immobilization and suboptimal functional results. There are reports showing that locking plates are biomechanically superior to nonlocking plates. The aim of this study was to compare elbow functional outcomes between locking and nonlocking plates in fixation of distal humerus fractures. A single-centre, randomized control study was conducted at an academic level 1 trauma centre. A total of 60 patients with type 13-A fracture (AO/OTA classification) were randomized into two equal groups, locking plates group, and nonlocking plates group. The primary outcome measure was the Mayo elbow performance score (MEPS) at one year. Secondary outcomes measures were elbow flexion/extension arc, union, operative time, and complications (e.g., infection, heterotrophic ossification). The Mayo Elbow Performance Score (MEPS) at one year was 88 ± 10.1 in locking plates group and 75.8 ± 12.8 in nonlocking plates group. The difference was found to be statically significant (P value = 0.01). Elbow flexion/extension arc of motion at one year was116° ± 15° in locking plates group and113° ± 28° in nonlocking plates. The difference was not found to be statistically significant (P value = 0.17). Both implants yield similar results, withlocking plates showing slightly better clinical scores.

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.

Modified use of a proximal humeral internal locking system (PHILOS) plate in extra-articular distal-third diaphyseal humeral fractures

BackgroundSurgical treatment of extra-articular distal-third diaphyseal humeral fractures is controversial in terms of surgical approach and position of implant. The aim of this study is to evaluate the clinical and radiological outcomes of a modified application of the proximal humeral internal locking system (PHILOS) plate in extra-articular distal-third diaphyseal humeral fractures. Materials and methodsA total of 23 patients with extra-articular distal humerus fractures were treated using either open plating or the minimally invasive plate osteosynthesis (MIPO) technique with upside down application of the PHILOS plate. Fracture configuration, number of screws in the distal fragment, and time to union were analysed. Elbow range of motion, Mayo Elbow Performance Score (MEPS), and complications were evaluated at the final follow-up. ResultsFracture union was obtained in all patients at a mean postoperative time of 20.8 ± 2.9 weeks. The mean shortest and longest cortical lengths were 50.7 ± 14.0 mm and 85.2 ± 12.4 mm, respectively. The average number of screws in the distal humeral fragment was 5.6 ± 0.7. No statistically significant correlation was observed between the shortest cortical length and number of screws in the distal fragment (p = 0.224) or between the longest cortical length and the number of screws in the distal humeral fragment (p = 0.956). The average MEPS was 97.6 (range, 75–100). No postoperative complications that required reoperation were occured. ConclusionA modified anterior application of the PHILOS plate in extra-articular distal-third diaphyseal humeral fracture showed satisfactory outcomes, so it is an alternative when considering the ability to increase plate-screw density with locking screw fixation in a distal humeral fragment. Level of evidenceTherapeutic level IV, case series.

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>

Study of surgical fixation of extra-articular distal third humerus fractures with a posterolateral locking compression plate

<p class="abstract"><strong>Background:</strong> Fractures of the adult distal humerus account for approximately 2% of all fractures and represent a third of all humerus fractures. Fractures of the distal third of the humerus are challenging injuries due to their peri-articular location, small size of the distal bone fragments, and the osteopenic quality of the bone in older adults. Aim of our study was to evaluate the clinical, radiographic and functional outcomes of posterolateral locking compression plate for extra-articular distal third humerus fractures through posterior triceps splitting approach.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study done at All India Institute of Medical Sciences, Patna in which 30 consecutive skeletally mature, closed extra-articular distal humerus fractures underwent fixation with posterolateral locking compression plate and outcome evaluated in terms of radiological evidence of healing, functional outcome and complications if any.<strong></strong></p><p class="abstract"><strong>Results:</strong> Use of posterolateral plate results in predictably good union rates and excellent results terms of patient outcome without any implant related complications.</p><p class="abstract"><strong>Conclusions:</strong> We recommend using this posterolateral plate for these humerus fractures, because of its consistent results with respect to fracture union, stability across the fracture site and early mobilization for better functional results.</p>

Clinical study on the management of extra-articular distal humerus fracture treated with extra-articular distal humeral locking compression plate

Background: Extra-articular distal humerus fracture treatment is a controversial topic. One group of surgeons favor non-operative treatment with plaster cast immobilization and functional bracing, while the other favors operative fixation. Concern of radial nerve injury, mal aligned fracture ends and stiffness of the shoulder and elbow following non-operative treatment are the major reasons to opt for an operative fixation. Distal humerus fractures surgeries remain one of the most challenging orthopaedic surgeries. These fractures have a complex anatomy, occurs in osteoporotic bone and are commonly multi-fragmented. The Extra-articular Distal Humeral Locking Compression Plate is a useful treatment option for managing extra-articular distal humerus fractures. Due to the greater screw hole density of the plate distally and using 3.5-mm screws instead of 4.5 mm allows adequate number of screws to be placed to hold the small distal fragment. Materials and Methods: A prospective clinical study was carried out for a total of 20 cases of extra-articular distal humeral fractures between 18 years and 65 years attending OPD and Emergency Department of Orthopaedics, Silchar Medical College and Hospital who meet inclusion and exclusion criteria from 1st June 2017 to 31st May 2018. All the cases were operated with EADHP. The time for union, range of motion at elbow and complications were recorded in followup. The elbow function was assessed using the Mayo Elbow Performance Score (MEPS) and pain by Visual Analogue Score (VAS). Results: There were 20 patients (13 males and 7 females) with an average age of 38.85 years. 10 cases were 12B1; 3 cases were 12A1; 2 cases each were 12A2, 12B2 & 12C1 and 1 case was 12C2. The mean time of radiological union was 14.25 weeks. The average duration of follow-up was 9.25 months with a range of 6-12 months. The average range of motion in the study at the 6 months analysis was 0.500 – 125.50. The mean Mayo Elbow Performance Score at the end of 6 months was 95.5, and ranged from 80 to 100. The average visual analogue score was 0.745 cm at the end of 6 months and ranged from 0 to 4cm. All the fractures showed union except one. There was one incidence of plate failure which was reoperated and it got united after 20 weeks of the revision surgery. There were 4(20%) patients who had complications. Two patients had post-operative neuropraxia, one patient had plate failure and in one patient there was loss of 100 extension. Conclusion: Extra-articular Distal Humeral Locking Compression Plate fixation of distal humerus fractures using the paratricepital approach provides stable fracture fixation with adequate exposure of the radial nerve and 90% of posterior humeral shaft surface.

Functional Outcomes after Triceps Splitting versus Triceps Sparing Approach for Extra-Articular Distal Humerus Fractures

Aim: To compare the functional outcome as well as elbow range of motion (ROM) after triceps splitting and triceps sparing approach for AO/OTA TYPE A distal humerus fractures. Materials and Methods: This is a prospective study done at our center between 2011 and 2014. A total of 50 patients presented with extra articular distal humerus fracture (AO/OTA 13 A2, 13A3). Exclusion criteria removed 16 patients from the study while 2 patients died due to medical comorbidities before the final follow up. Out of the remaining 32 patients, they were divided into two groups: triceps splitting (15 patients) and triceps sparing (17 patients). Elbow ROM, along with Disabilities of the Arm, Shoulder and Hand questionnaire scores, was compared between the two groups. Results: Triceps sparing group had greater elbow flexion (140.0 ± 4.0) compared to triceps splitting group (126.0 ± 10.0) with p Conclusion: As compared to triceps splitting approach, triceps sparing approach results in better elbow ROM with less extension contracture, however both approaches result in similar functional outcome.

Adolescent Distal Humerus Fractures: ORIF Versus CRPP.

Although supracondylar humerus fractures are common in young children, the incidence in adolescents is much lower. As a result, there is a paucity of literature to guide treatment. The purpose of this study was to review the treatment and outcomes for a consecutive series of distal humerus fractures in adolescents and to compare outcomes between patients treated with percutaneous skeletal fixation and those treated with open reduction and fixation. A retrospective review of patients 10 to 17 years of age who underwent surgical treatment for a distal humerus fracture from 2005 to 2014 was performed. Patients with medial epicondyle fractures and those with insufficient follow-up to document union or return of motion were excluded. Medical records were reviewed to collect demographic data as well as operative approach and method of fixation. Clinical outcomes included range of motion, time to maximum motion, and complications [nerve dysfunction, heterotopic ossification (HO), need for secondary surgery]. Radiographs were reviewed to determine time to union as well as coronal and sagittal alignment. One hundred eighteen adolescents with displaced distal humerus fractures were identified. Eighty-one met inclusion criteria. Forty-four of these were classified as extra-articular [Orthopaedic Trauma Association (OTA) 13-A], and 37 were intra-articular fractures (10 OTA 13-B and 27 OTA 13-C).Although not statistically significant, closed treatment with percutaneous fixation of extra-articular fractures resulted in greater flexion-extension arc of motion at final follow-up (128 vs. 119 degrees, P=0.17) and demonstrated more rapid return of motion (2.8 vs. 3.9 mo, P=0.05) when compared with open treatment despite a longer duration of immobilization and less formal physical therapy. Complications such as HO (P=0.05), nerve dysfunction (P=0.02), and secondary surgery (P=0.001) were more common in the open treatment group.Closed treatment with percutaneous fixation of intra-articular fractures was performed in younger patients of similar size (12.8 vs. 14.4 y, P<0.01; 154 vs. 142 lbs, P=0.5). There were no significant differences between groups in regard to outcomes or complications. There were trends toward increased frequency of HO, nerve dysfunction, and secondary surgery in the open treatment group.Patients with intra-articular fractures were older (14.2 vs. 11.5 y, P<0.001) and heavier (144 vs. 94 lbs, P<0.001) than patients with extra-articular fractures and were more likely to be treated open (74% vs. 11%, P<0.001). Extra-articular fractures demonstrated a greater total arc of motion (126 vs. 118 degrees, P=0.04) at final follow-up despite longer duration of immobilization (23 vs. 15 d, P=0.002), and less physical therapy (27% vs. 73%, P<0.001). Radiographic carrying angle (16.6 vs. 22.3 degrees, P=0.08) and anterior humeral line (95% vs. 81%, P=0.07) trended toward more anatomic alignment in the extra-articular group. Secondary surgery was more common after intra-articular fracture (24% vs. 7%, P=0.03). Closed reduction and pinning of extra-articular distal humerus fractures in adolescents resulted in predictable clinical and radiographic outcomes and allowed for earlier return of motion and fewer complications when compared with open treatment. Intra-articular distal humerus fractures occur more frequently in older adolescents and are more likely to require open reduction and internal fixation to obtain joint congruity. Patients with intra-articular injuries should be cautioned that regaining full elbow motion may be more difficult, and there is an increased risk for complications and need for additional surgery. Closed reduction and percutaneous fixation of intra-articular injuries appears to be a reasonable option in select patients. Level III-retrospective comparative study.

Functional outcome of extra-articular distal humerus fracture fixation using a single locking plate: A retrospective study.

The optimal method for fixation of extra-articular distal humerus factures poses a management dilemma. Although various plate configurations have been proposed, anatomic shaped extra-articular distal humerus locking plates have emerged as a viable solution for these complex injuries. We assessed clinico-radiologic outcome in our retrospective case series of extra-articular distal humerus fractures managed with these plates. Forty-five patients of extra-articular distal humerus fractures, who were operated at our level 1 trauma centre between January, 2012 and December, 2016, were identified. After exclusion, 36 patients were available for the final assessment. All patients were operated with the triceps-reflecting modified posterior approach. Regular clinico-radiologic follow-up was done evaluating elbow functionality, fracture union, secondary displacement, non-union, implant failure and any complications; Mayo Elbow Performance score (MEPS) was used for the final functional assessment. Twenty-four (66.7%) male and 12 (33.3%) female patients constituted the study group, who had an average follow-up of 15 months. Preoperatively three patients and post-operatively one patient had radial nerve palsy; all had neurapraxia and recovered completely. Overall, 34 (94.4%) patients were adjudged to have complete radiological union within 3 months; 2 (5.5%) patients developed non-union. Mean flexion achieved was 122.9° ± 23°, and mean extension was -4.03° ± 6.5°; 1 patient with head injury developed flexion deformity of 45°. Average MEPS at the final follow-up was 90.8° ± 9.9°. Stable reconstruction and early initiation of physiotherapy are utilitarian to envision optimal outcome; the use of precontoured extra-articular distal humerus locking plates has yielded satisfactory results with minimal complications in our hands.

Antero-lateral minimally invasive plate osteosynthesis (MIPO) with the radial nerve exploration for extra-articular distal-third diaphyseal fractures of the humerus.

Traditional open reduction and internal fixation (ORIF) of extra-articular distal humerus fractures has a risk of iatrogenic radial nerve injury, extensive soft tissue stripping, and long incision scar. We performed an antero-lateral minimally invasive plate osteosynthesis (MIPO) technique with the radial nerve exploration for distal-third diaphyseal fractures of the humerus and evaluated clinical and radiographic outcomes through this respective study. From April 2010 to June 2016, 28 cases of extra-articular distal-third diaphyseal fractures were treated with an antero-lateral MIPO procedure. Patient demographics, Disabilities of the Arm, Shoulder and Hand (DASH) Score, Mayo Elbow Performance (MEP) Score, elbow range of motion, scars and post-operative complications were recorded and analyzed. All fractures were united with a mean time of 3.5months. One patient exhibited delayed union (3.6%). The mean DASH Score was 6.6, and all patients had excellent or good MEP Score values. The average scar length was 6.8cm, and the shortest was 4.5cm. The MIPO technique via an antero-lateral approach for extra-articular distal-third diaphyseal fractures of the humerus results in satisfactory clinical outcomes. Level IV, case series, treatment study.