Humerus Fractures In Adults Research Articles

MANAGEMENT AND OUTCOME ANALYSIS OF PROXIMAL HUMERUS FRACTURES BY PHILOS - A PROSPECTIVE STUDY

Introduction: Proximal humerus fracture is considered as one of the commonest fractures in clinical practice. Most of these fractures occur as a result of osteoporosis. Proximal humerus fractures are often nondisplaced or minimally displaced fractures with two parts, which can be managed conservatively. Surgical interventions include closed reduction and percutaneous pinning (CRPP). It also involves trans-osseous suture fixation, Open Reduction Internal Fixation (ORIF) with either conventional or Proximal Humerus Interlocking Osteosynthesis System (PHILOS) or hemiarthroplasty. Good clinical outcomes have been achieved by the PHILOS as they stabilize the proximal humeral fractures with steady fixation in osteoporotic bone and assisted aged patients in early functional exercises which resulted in early recovery. 
 Aim: To analyse the functional results and complications associated with management of proximal humerus fractures treated with PHILOS.
 Materials and Methods: This is a prospective study conducted at Department of Orthopaedics, Prathima Institute Of Medical Sciences, Nagunur, Karimnagar, from July 2017 to January 2019. 58 patients were taken into study with two-part, three-part, four-part fracture of the proximal humerus in adults >18 years of age. In all patients PHILOS plating was done and surgical events and surgical difficulties faced, post-surgery local or systemic complications, time needed for fracture union and time taken to return to pre-fracture activity were documented. They were followed up till there were signs of union on radiographs or for at least a period of 1 year.
 Results: The results were assessed with Constant Murley Score at 6 months post-surgery and Visual Analogue Scale at 6 weekly intervals. The mean Constant score for two-part fractures was 88.1, for Three-part 82.5, for Four-part 72.7. The patients with two-part and three-part fractures had a significantly better VAS than patients with four-part fractures till 18 months of surgery. After 18 months the VAS was similar for all 3 groups. 6.9% developed shoulder stiffness, 2 patients from four-part fracture group developed Varus angulation.
 Conclusion: we conclude that the PHILOS is safe, effective and provides stable fixation for proximal humerus fractures and in patients with indigent bone quality. 
 Keywords: PHILOS, Proximal Humerus Fracture

Comparative study of intramedullary nailing versus plating for shaft fractures of humerus in adults

Comparative study of intramedullary nailing versus plating for shaft fractures of humerus in adults

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

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

Study of functional outcome of surgical management of distal humerus fractures with bicolumnar plating

INTRODUCTION: Distal humerus fractures in adults comprise 2% of all fractures and 30% of all humeral fractures. Intra-articular distal humerus fractures account for 37% and involve both medial and lateral columns. Most of the distal humeral fractures in adults must be treated surgically to get better functional outcome. The aim of this study was to assess the efficacy, technical requirements, functional outcome, radiological and clinical union, and complications of distal humerus fractures treated with bicolumnar plating. MATERIALS AND METHODS: This was a prospective study of 35 cases of distal humerus fractures conducted at a tertiary care hospital, who were treated surgically with bicolumnar plating using posterior approach with transolecranon osteotomy between 2016 and 2018. The Mayo Elbow Performance Score was used for the assessment of functional outcome. RESULTS: Thirteen (37.14%) patients got excellent outcome, 17 (48.58%) got good outcome, 4 (11.42%) got fair outcome, and 1 (2.86%) got poor outcome, and the complications observed were infections, nonunion, implant failure, and elbow stiffness. Distal end radius fracture was the common association with distal humerus fracture in our study. CONCLUSION: Open reduction and internal fixation with bicolumnar plating is the treatment of choice for distal humerus fracture mainly in type B and C fractures. Fracture types, use of locking plates, stable fixation, and meticulous repair of soft tissues along with early elbow mobilization influence the final functional outcome. Bicolumnar plating provides better stability, allows early elbow range of motion, and prevents stiffness.

Functional outcome of surgical management of distal end humerus fractures in adults: A prospective study

Introduction: Distal humerus fractures are uncommon injuries that account for fewer than 2%of all adult fractures. The aim of the study is to evaluate the functional outcome of the surgical management of distal humerus fractures in adults treated by various methods using the postoperative functional criteria by Riseborough and Radin.Materials and Methods: A Prospective clinical study was conducted over a period of 2 years which included 20 patients in tertiary care centre. The patients were treated with primary open reduction and internal fixation.Results: The average age of the patients in our study was 35.8 years with a range of 23-53 years. In our series, according the Riseborough and Radin criteria, the results were good in 50% patients, Fair in 35% and Poor in 15% patients.Conclusion: Operative treatment with rigid anatomical internal fixation should be the first line of treatment for all grades of Riseborough Radin intercondylar fractures, more so in young adults as it gives best chance to achieve good elbow function. Vigorous, active physiotherapy is a must for good results. Stable fixation allows early, active and aggressive post-operative mobilization.

Evaluation of Results of Intercondylar Fracture of Humerus in Adults Treated by Various Surgical Modalities

Evaluation of Results of Intercondylar Fracture of Humerus in Adults Treated by Various Surgical Modalities

Incidence of Osteoporotic Refractures Following Proximal Humerus Fractures in Adults Aged 50 Years and Older in Korea.

BackgroundThe purpose of this study was to investigate the incidence and characteristics of osteoporotic refractures after proximal humerus fracture in Korean adults aged above 50 years.MethodsPatients aged 50 years or older with initial proximal humerus fractures reported in 2012 were enrolled and followed up until 2016 using the Korean National Health Insurance data. Based on the last claim date, the refractures were classified as osteoporotic fractures including spine, hip, distal radius, and humerus 6 months after the index fracture involving the proximal humerus. Each osteoprotic fracture was identified using specific International Classification of Diseases, 10th Revision codes and site-specific physician claims for procedures.ResultsA total of 5,587 first-time fractures involving proximal humerus were reported in 2012. Among them, a total of 1,018 osteoporotic refractures occured between 2012 and 2016. The total cumulative incidence of osteoporotic refractures was 4.85% (271/5,587) at 1 year, 9.61% (537/5,587) at 2 years, 14.21% (794/5,587) at 3 years, and 18.22% (1,018/5,587) at 4 years. In terms of site by year, the incidence of associated refractures was as follows: spine, 48.62% (495/1,018); hip, 25.83% (263/1,018); wrist 18.57% (189/1,018); and humerus 6.97% (71/1,018) during all the follow-up periods.ConclusionsOur study showed that the cumulative incidence of osteoporotic refractures following proximal humerus fractures in the elderly population has been increasing over the years. Given that osteoporotic refractures are associated with an increased mortality risk, a public health strategy to prevent the refracture after proximal humerus fracture in the elderly is imperative.

Study on surgical management of distal humerus fractures in adults treated with bicolumnar plating

Background & Objectives: Distal humerus fractures in adults comprise 2% of all fractures and 30% of all humeral fractures. Intra-articular distal humerus fractures account for 37% and involve both medial and lateral columns. Most of the distal humeral fractures in adults must be treated surgically to get better functional outcome. The aim of this study was to assess the efficacy, technical requirements, functional outcome, radiological and clinical union, and complications of distal humerus fractures treated with bicolumnar plating. Aims and Objectives: The Aim of the present study is to evaluate the Functional Outcome of Surgical Management of distal Humerus fractures by Open Reduction and Internal using bicolumnar plating technique. Materials and Methods: A total of 30 distal humerus fractures admitted in teaching and general hospital were operated included in the study. Patients fitting in to inclusion criteria were selected. All the patients were operated with ORIF with precountered locking distal humerus plates in orthogonal fashion and outcome was measured by MEPS, rate of union, rate of complications and final range of motion. Results: In our series of 3 0 cases, there were 22 males and 8 females with average of 36.8 years. 17 cases were due to direct fall, 10 due to road traffic accident and 3 due to direct assault. There was a predominance of left side (24). Out of 30 cases, 6 (20%) were of 13C1 type, 21(70%) were of 13C2 type and 3 (10%) were of 13C3. Excellent results in 21, good in 6 and fair in 3 cases, according to MEPS. There were 3 (10%) cases each of superficial infection and 3 (10%) cases of ulnar neuropathy, treated accordingly. There were no cases of non-union, implant failure or heterotopic ossification. Conclusion: Operative treatment with rigid anatomical internal fixation, should be the line of treatment for fractures of distal humerus, as it gives best chance to achieve goodelbow function. During open reduction and internal fixation, anatomic reconstruction of articular surface should be given prime importance. Stable fixation allows early active and aggressive postoperative mobilization.

Occurence of distal third shaft humerus fractures in adults

This study has been done to know the causes of occurrence of closed distal third shaft of humerus fracture, in this study 20 patients of fresh fractures of distal shaft humerus studied between January 2015 to March 2016 in Mamta general and super specialty hospital, Khammam. Among these 70% males and 30% females, average age group is 4th decade and RTA was the chief cause of fractures accounting for 80% and right side accounts for 60%. This is comparable with other series like Fawi et al. reported average age 47.5 years, male preponderance, RTA was the chief cause and right side accounts for 52% and John T. capo et al where average age is 39 years, 57.2% males.

To assess the functional results of surgical management of distal humerus fractures in adults involving the articular surface

To assess the functional results of surgical management of distal humerus fractures in adults involving the articular surface

No incidence of glenohumeral joint dislocation in a review of 220 paediatric proximal humerus fractures.

:PurposeProximal humerus fractures in adults are approached with a high suspicion for potential associated glenohumeral dislocation. Axillary views of the shoulder can be painful and possibly even lead to dynamic angulation of the proximal humerus fracture. The incidence of associated glenohumeral dislocation in the paediatric population is unclear and it would be useful to determine whether children with proximal humerus fracture require specific axillary view imaging to rule out dislocation.MethodsWe retrospectively reviewed 220 proximal humerus fractures in 218 total children. Imaging and follow-up clinic notes were reviewed for potential glenohumeral dislocation.ResultsAverage patient age was 9.8 years SD 3.8 with 55% of the patients male and a wide variety of mechanisms of injury. None of the 220 fractures evaluated showed radiographic evidence of a shoulder dislocation, and all 218 children had a follow-up appointment at least 21 days after the injury without any clinical concern of a missed shoulder dislocation.ConclusionNo paediatric patients presenting with proximal humerus fractures had a corresponding glenohumeral joint dislocation in our relatively large series. We recommend obtaining this additional imaging only in cases with higher energy mechanisms, if there is suspicion of subluxation or dislocation on anteroposterior and scapular-Y views or if there is clinical concern.Level of EvidenceLevel III Diagnostic

Study of surgical management of distal third shaft humerus fractures by extraarticular distal humerus locking compression plate in adult patients

This study has been done to evaluate the functional results and complications following surgical fixation by extra articular distal humerus locking compression plate for closed distal third shaft of humerus fractures in adults, In this study 20 patients of fresh fractures of distal third shaft of humerus treated surgically by internal fixation with extra articular distal locking compression plate studied between January 2015 to march 2016 in Mamta general and super specialty hospital, Khammam. Surgeries were performed within 2-3 days average. All cases treated by open reduction and internal fixation with extraarticular distal locking compression plate. All the fractures united with a union rate of 90%. Radiological union was possible in 13.9 weeks, there were two case of radial nerve neuropraxia and one patient develops superficial infection. Functional outcome as per mayo elbow performance score was excellent in 18 cases and good in 2 cases.

Surgical approaches for open reduction and internal fixation of intra-articular distal humerus fractures in adults: A systematic review and meta-analysis

BackgroundA number of surgical approaches have been described for open reduction and internal fixation (ORIF) of intra-articular distal humerus (IDH) fractures in adults. However, there is no consensus as to which approach is better in terms of functional outcomes and complications. The purpose of this study was to determine whether the functional outcomes and types and rates of complications are influenced by the choice of surgical approach for ORIF of IDH fractures (AO/OTA types 13 B & C). MethodsA systematic review of literature was performed using the PubMed, EMBASE and Cochrane Database of Systematic Reviews databases. Studies, both prospective and retrospective and comparative or non-comparative, dealing with surgical approaches for ORIF of IDH fractures in adult patients were included. Conference abstracts, studies looking primarily at the results of internal fixation rather than the surgical approach, those including extra-articular distal humeral fractures, pediatric distal humeral fractures (<18 years of age), delayed unions, non unions, malunions, cadaveric studies, pathological fractures and studies with <10 patients were excluded. Studies that looked at surgical modalities other than internal fixation (for e.g. total elbow arthroplasty) for intra-articular distal humerus fractures or those that did not report a validated functional outcome scoring system were also excluded. Results11 studies were included in the qualitative analysis, of which 5 were comparative studies and 6 were non-comparative. Quantitative analysis was performed on two sets of two studies, each set comparing the Bryan and Morrey or the triceps-split approach to the olecranon osteotomy approach, and revealed no significant differences in the Mayo Elbow Performance Score, range of motion and rates of complications. The overall methodological quality of the studies included in the review was low. ConclusionsHigh-quality evidence on surgical approaches for ORIF of IDH fractures in adults is lacking. Evidence from low-quality studies indicates that there is no difference in the functional outcomes or complication rates when comparing the Bryan and Morrey or triceps-split to the olecranon osteotomy approach. Future research in the form of high-quality randomized controlled trials is needed to determine which approach is superior in terms of functional outcomes and complications.

Middle third humerus fractures in adults: Intramedullary nails vs. locking compression plates

Background: 2 to 3% of all traumatic fractures in adults encountered by orthopaedic surgeons are humerus fractures. Operative management for these fractures has now gained popularity among surgeons to allow patients an early recovery and return to premorbid conditions. We compared the two commonly used implants for treating humerus shaft fractures, that is, locking compression plates and intramedullary nails in terms of complications associated and range of movements. Materials and methods: 40 patients were allotted into 2 groups, with 20 undergoing treatment with locking compression plates and 20 undergoing intramedullary nailing. The 2 groups were comparable when pre-operative demographics were analysed. Post-operative follow up showed the following results. Results: Axillary nerve injuries were noted in 4 out of the 20 patients in the nailing group and radial nerve palsy was note in 1 patient in the plating group after surgery. 2 cases of superficial wound infection and 1 case of deep wound infection were recorded in the plating group. 1 patient in each group were found to have delayed union. A significantly higher incidence of shoulder stiffness was recorded in the intramedullary nailing group. A significant difference in the DASH score was recorded, in favour of the plating group. This could be attributed to the pain free movements at shoulder joint. A significant difference in the Rodrigues Merchan outcome was seen, in favour of the plating group, with 70% patients having achieved good to excellent outcome, as opposed to 25% in the nailing group. A higher incidence of poor outcomes was seen in the nailing group due to shoulder related complications. Conclusion: We concluded that Open reduction and internal fixation with locking compression plates gave a better outcome to patients when followed up after surgery as compared to closed reduction and internal fixation with interlocking nails, primarily due to the shoulder related complications associated with intramedullary nailing.

WITHDRAWN: Functional outcomes of type C distal humerus fractures in adults fixed by orthogonal double plating

Background: Surgical reconstruction of intra-articular distal humerus fractures imposes a challenge to even experienced surgeons as it is complicated by anatomy of elbow, small area of fixation, associated comminution, and osteopenia of articular surfaces. Single-column plating does not provide stable construct for comminuted distal humerus fractures as compared to the double-column plating methods. The purpose of this study is to evaluate the functional outcomes, technical difficulties, complications, and patients' satisfactions after orthogonal double plating. Materials and Methods: This was a retrospective analytical study of 54 patients with Type C distal humerus fractures fixed with orthogonal plating from 2012 to 2016. Time to unite the fractures and functional outcomes along with other major and minor complications were noted. Results: Seven (13%) fractures were C1, 12 (22.2%) were C2, and 35 (64.8%) were C3 types according to the AO classification. Major complications were noted in 5 patients and minor complications in 19 patients. Eleven (20.4%) patients were rated as excellent, 33 (61.1%) rated as good, 7 (12.9%) rated as fair, and 3 (5.6%) rated as poor. Mayo Elbow Performance Score in overall patients (n = 54) was 81.62 ± 10.28, C1/C2 subgroup (n = 19) was 89.05 ± 60, and C3 subgroup was 77.60 ± 9.91 (P = 0.627). Similarly, the Disabilities of the Arm Shoulder and Hand Score in overall patients was 17.96 ± 15.67, C1/C2 subgroup was 8.78 ± 7.07, and C3 subgroup was 22.82 ± 16.78 (P = 0.285). Conclusion: Orthogonal dual-plate configurations can provide anatomical reconstruction and stable fixation of Type C intra-articular distal humeral fractures and allow early mobilization of the elbow after surgery; however, a significant number of patients do not satisfy after surgery.

Elastic Stable Intramedullary Nailing for Closed Diaphyseal Fractures of Humerus in Adults. A Case Series of 28 Patients

Aim of study: To demonstrate clinical and radiological effectiveness of intramedullary fixation of closed diaphyseal humeral fractures in adults using the elastic stable intramedullary nail (ESIN). Patients and methods: Between May 2011 and December 2013, twenty-eight patients (19 males) with closed diaphyseal humeral fractures treated with closed reduction and percutaneous fixation with 2 elastic stable nails. Age from 18 to 56 years (mean, 29 years). Patients with open or pathological fractures, those less than 18 years and medically unfit patients were excluded. Causative injury was pedestrian vehicular accident in 15, fall from height 9 and sport-related activity 4 patients. The time of surgical intervention varied from 24 to 72 hours post-injury. Results: Patients were followed up 12-31 months with an average of 20 months. X-ray films showed that twentysix fractures united completely at a range 14-20 week (mean, 13.1 weeks). Twenty-Six cases healed in good alignment at a median time of 13.1 weeks (range 14–20 weeks). One case developed delayed union where bone marrow injection and longer immobilization till full healing done. One case developed non-union which was treated by bone grafting and plating. There were no intraoperative complications. One patient with preoperative radial nerve injury recovered spontaneously by eight weeks. Patients followed and assessed using Disabilities of the Arm, Shoulder and Hand score (DASH). At last follow-up, the average DASH score was 90.5 (range 60–100). Final clinical evaluation showed 17 cases Excellent, 8 cases Good, 2 cases fair and one case Poor according to previous score. Conclusion: Elastic stable nail fixation is a good procedure for treating adult humeral shaft fractures in which stabilization is indicated as it provides stable fixation, with minimal soft tissue stripping at the fracture site and allows early mobilization of the extremity.

A prospective study to analyze the outcome of proximal humerus fracture managed with proximal humerus locking plate

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; The incidence of proximal humerus fractures has increased in last few years due to changes in life style and increase in road traffic accidents. Hence, the challenge of the modern day treatment was to get accurate reductions anatomically, fast healing and early restoration of function. Proximal humerus locking plate revolutionized the treatment without compromising fracture union. The present study aimed to evaluate the functional and radiological outcome of proximal humerus fracture managed with proximal humerus locking plate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study was conducted at Narayana Medical College Hospital for a period of two years from December 2014 to June 2016. 30 cases of proximal humerus fractures in adults after meeting inclusion criteria were participated and treated surgically with proximal humerus locking plate technique. Consent form was taken from all the patients. The final functional outcome was assessed by radiography and DASH scoring system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Proximal humerus fractures were found to have high incidence in the 40 to 45 age group which had 37% of the study population. Males predominated over females in our study. Ratio of males to female was 2:1. Right sided fractures are more in the present study in both the sexes. The most common mechanism of injury was fall on the outstretched hand from a standing height or less with minor trauma seen in 34% of patients. High energy trauma was more frequently involved in younger patients (30%). According to Neer’s classification two part fractures constituted the most common type 16 (54%) in this study. The collected data was analyzed using SPSS software version 23.0. A ‘p’ value less than 0.05 was considered significant.&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The proximal humerus locking plate method for proximal humerus fracture emerges to be safe, effective, reliable fixation with minimal complications.

A prospective study of surgical management of distal end humerus fractures in adults

Introduction: Distal humerus fractures are uncommon injuries that account for fewer than 2% of all adult fractures. The aim of the study is to evaluate the functional outcome of the surgical management of distal humerus fractures in adults treated by various methods using the post-operative functional criteria by Riseborough and Radin and the Mayo Elbow Performance Index (MEPI). Materials and Method: A Prospective clinical study was conducted over a period of 4 years which included 93 patients in tertiary care centre. The patients were treated with primary open reduction and internal fixation using 3.5 mm reconstruction plates, 4 mm cannulated cancellous screws, bipillar plating using reconstruction plating, K-wires and Y plate or a combination of the above methods using a posterior approach. Results: The average age of the patients in our study was 42.91 years with a range of 18-72 years. In our series, according the Riseborough and Radin criteria, the results were Good in 55(59.13%) patients, Fair in 32(34.4%) and Poor in 6(6.45%) patients. According to MEPI, we had Excellent results in 20(21.5%), Good in 43(46.2%), Fair in 25(26.8%) and Poor in 5(5.37%) patients. Conclusion: Operative treatment with rigid anatomical internal fixation should be the first line of treatment for all grades of Riseborough Radin intercondylar fractures, more so in young adults as it gives best chance to achieve good elbow function. Vigorous, active physiotherapy is a must for good results. Stable fixation allows early, active and aggressive post-operative mobilization.

Surgical management of intercondylar fracture of distal humerus in adults by olecranon osteotomy

Surgical management of intercondylar fracture of distal humerus in adults by olecranon osteotomy

Comparison of 90° and 180° plate constructions for comminuted distal humerus fractures in adults, and effects on clinical results

The present objective was to compare 90° and 180° double-plate constructions for complex distal humerus fractures, as well as to evaluate superiority of construction type. Retrospectively evaluated were 17 patients treated for type C distal humerus fracture according to AO/ASIF classification between January 2009 and January 2013. All attended minimum 6-month follow-up. Elbow function was assessed with anteroposterior and lateral x-ray, and Mayo elbow performance score evaluation at outpatient clinics. Patient population included 14 males (82.3%) and 3 females (17.7%). Mean patient age was 40.5 years. According to AO/ASIF distal humerus classification, 3 (17.7%) type C1, 9 (52.9%) type C2, and 5 (29.4%) type C3 fractures were included. Six were open fractures (35.3%). According to Gustilo-Anderson classification, 4 (23.5%) fractures were type 1, and 2 (11.7%) were type 2. Construction performed was 90° in 11 cases (64.7%) and 180° in 6 cases (36.3%). Chevron osteotomy was performed in all cases. Mean follow-up period was 25.6 (6-52) months. Upon final examination, mean elbow flexion was 105º (85º-130º), and mean extension loss was 10º (0º-20º). According to Mayo elbow performance scoring system, 12 (70.5%) results were excellent, and 5 (29.5%) were good. No statistically significant clinical difference was found between 90° and 180° plate construction groups (p=0.169). Surgeons should determine the construction type appropriate to individual cases of adult distal humerus type C fractures using preoperative x-rays and intraoperative means. Choice of construction type has particular importance in cases of lateral columnar fracture complexity. If no comminution is present in the lateral column, 90º double-plating leads to satisfactory outcome, while 180º plating leads to satisfactory outcome when comminution is present in the lateral column.