Intercondylar Fracture Of Distal Humerus Research Articles

Comparative study between bi-columnar plating as opposed to double tension band osteosynthesis in inter-condylar distal humerus fractures in adults

Introduction: Distal humerus fractures with inter-condylar extension are unusual in Orthopaedic practice. The treatment for the same has been defined inside the literature and consists of parallel and orthogonal fixation with the aid of using plates. The study aimed to observe the effectiveness of “double tension band wiring” method for the remedy of distal humerus fractures with inter-condylar extension and compare the effects with studies related to its treatment with locking plates. Materials and methods: 50 patients, all presenting with closed fractures of the distal humerus, out of them 20 have been dealt with double tension band wiring procedure and 30 were treated with locked plates fixation method. Results: Out of 50 cases treated with these 2 methods of internal fixation, rigid fixation and union was achieved in each and every patient. The mean duration of use of tourniquet during surgery was 65 minutes with minimum of 54 minutes and maximum of 110 minutes. Complete radiological union of the fracture was seen at a mean duration of 11 weeks after the surgery (9-15 weeks). Average range of motion was 103 degrees with maximum range of motion of 110 degrees (20-130 degrees) and minimum of 65 degrees (25-90 degrees). Good results were obtained in both the groups in our study. Conclusion: Both the approaches of treatment gave good results. Union became accomplished in almost all instances. However, implant related difficulty become more with locked plates. Double tension band is a reliable, easier, inexpensive and safe technique of fixation of inter-condylar fractures of distal humerus in adults.

Olecranon osteotomy vs. triceps-sparing for open reduction and internal fixation in treatment of distal humerus intercondylar fracture: a systematic review and meta-analysis

BackgroundThe open reduction and internal fixation (ORIF) was a standard treatment approach for fracture at distal humerus intercondylar, whereas the optimal way before ORIF remains inconclusive. We, therefore, performed a systematic review and meta-analysis to assess the efficacy and safety of olecranon osteotomy vs. triceps-sparing approach for patients with distal humerus intercondylar fracture.MethodsThe electronic searches were systematically performed in PubMed, EmBase, Cochrane library, and Chinese National Knowledge Infrastructure from initial inception till December 2019. The primary endpoint was the incidence of excellent/good elbow function, and the secondary endpoints included Mayo elbow performance score, duration of operation, blood loss, and complications.ResultsNine studies involving a total of 637 patients were selected for meta-analysis. There were no significant differences between olecranon osteotomy and triceps-sparing approach for the incidence of excellent/good elbow function (odds ratio [OR]: 1.37; 95% confidence interval [CI]: 0.69–2.75; P = 0.371), Mayo elbow performance score (weight mean difference [WMD]: 0.17; 95% CI: −2.56 to 2.89; P = 0.904), duration of operation (WMD: 4.04; 95% CI: −28.60 to 36.69; P = 0.808), blood loss (WMD: 33.61; 95% CI: −18.35 to 85.58; P = 0.205), and complications (OR: 1.93; 95% CI: 0.49–7.60; P = 0.349). Sensitivity analyses found olecranon osteotomy might be associated with higher incidence of excellent/good elbow function, longer duration of operation, greater blood loss, and higher incidence of complications as compared with triceps-sparing approach.ConclusionsThis study found olecranon osteotomy did not yield additional benefit on the incidence of excellent/good elbow function, while the duration of operation, blood loss, and complications in patients treated with olecranon osteotomy might be inferior than triceps-sparing approach.

Management of intercondylar humerus fracture using jess fixator in adults: A hospital based prospective study

Introduction: Intercondylar fracture of distal humerus is one of the difficult fracture involving the humerus in adults. Intercondylar fracture distal humerus in adults are difficult to manage due to complex anatomy of elbow. We present a method of surgical treatment of intercondylar humerus fracture in adults by open reduction with JEES fixator and to evaluate functional outcome and associated complication with application of JESS fixator.Materials & Methods: It is Institutional based, prospective study carried out from June 2018 to May 2019.Twenty cases of intercondylar distal humerus fracture were reduced and fixed with K-wire and finally JESS was applied. Patient were follow up at 1week, 4weeks, 6weeks & 12weeks and clinically evaluated with Mayo’s elbow performance score. Results: According to AO classification 4 cases had C1 fractures, 14 cases had C2 fractures and and 2 cases had C3 fractures. 3 cases had open injury among which two were of C2 and 1 were C3 type. All cases were operated using paratricipital approach and average duration of JESS application was 7 week and mean follow up duration was 9 months. Irrespective of injury pattern 9(45%) cases showed excellent results, 7(35%) showed good results, 3(15%) cases showed fair results and 1(5%) case showed poor results.Discussion: The goal of intercondylar fracture management by JESS technique is to achieve early range of motion of anatomically align joint. Conclusion: This study shows comparatively good results using JESS fixator. This procedure is viable alternative option to ORIF dur to its simplicit, cost-effectiveness and easy implant removal on day care basis.

A study of functional outcome after osteosynthesis of intercondylar fracture of distal humerus in adults with pre-contoured locking compression plate system

<p class="abstract"><strong>Background:</strong> Intra-articular fracture of distal humerus is considerable cause of morbidity in adults. The new pre-contoured LCP system provides better angular stability in fixation of inter-condylar distal humerus fracture.</p><p class="abstract"><strong>Methods:</strong> A prospective study of 25 patients with distal humerus fracture treated with pre-contoured double plate system is conducted in Department of Orthopaedics, RIMS, Ranchi between April 2017 to March 2018. These patients were followed up 3 weekly in first 3 months, then 6 weekly in next 6 months, then at every 3 month interval. Clinical and functional outcome was evaluated on the basis of Mayo elbow performance score (MEPS).<strong></strong></p><p class="abstract"><strong>Results:</strong> 24 fixed elbows were reviewed at a follow-up period of 1 year. Results obtained were graded on the basis of MEPS, 21 patients (87.5%) were graded excellent to good, fair in 2 patients (8.3%) and poor in 1 case (4.1%). Average time interval between surgery and admission was 9 days (average 4-14 days). All the fractures as well as the olecranon osteotomies united by 10-16 weeks (12.56 weeks). Superficial wound infection and transient ulnar nerve palsy was reported in 3 (12.5%) and 1 (4.16%) respectively and was managed conservatively. 1 patients did not reported in follow up.</p><p class="abstract"><strong>Conclusions:</strong> We conclude that osteosynthesis with pre contoured dual plating of closed intracondylar distal humerus fractures provide good fixation and early rehabilitation, leading to high rate of bone union and minimal soft tissue damage.</p>

Functional outcome of surgical management of intercondylar fracture of distal humerus in adults by olcranon approach- A retrospective study

Functional outcome of surgical management of intercondylar fracture of distal humerus in adults by olcranon approach- A retrospective study

The role of open reduction and internal fixation in the treatment of the intercondylar fractures of humerus

<p class="abstract"><strong>Background:</strong> Inter-condylar fractures represent one of the most complicated and challenging fractures in the upper extremity. The results of managing these fractures non-operatively are limited by failure to get anatomical reduction and early mobilization, which often results in painful stiff elbow and/or pseudo-arthrosis. The objective of this study was to evaluate and analyse the role of open reduction and internal fixation in inter-condylar fractures of distal humerus.</p><p class="abstract"><strong>Methods:</strong><strong> </strong>The present study was done in Malla Reddy Institute of Medical Sciences between June 2014 and June 2017. Out of 34 cases of intercondylar fractures of humerus admitted during the period, 25 patients were selected for the study that satisfied our inclusion criteria. Three patients out of those selected could not be included in the study as one had cardiac issues pre-operatively, one refused surgery and one was lost to follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> Our study included 22 patients, 14 male and 8 female patients. Their average age was 41.4 years. The fractures were classified as per the AO classification. There were B1-3, B2-1, C1-6, C2-5, C3-7 fractures. Both compound and closed fractures were included. All the patients were operated by posterior olecranon Chevron osteotomy approach by a senior faculty member. Twenty two patients who satisfied our inclusion criteria were treated, followed up and the results analyzed using Cassabaum’s scale of elbow function we had 86% of excellent to good results. Our results are comparable with other similar studies.</p><p class="abstract"><strong>Conclusions:</strong> Posterior olecranon approach was found to be of most satisfactory approach by us. It allows good exposure of the joint and the ulnar nerve.</p>

High T intercondylar fracture of the distal humerus in a 5 year old child: Case report

Introduction: Intercondylar fracture of distal humerus is a rare paediatric orthopaedic entity. Only 55 cases of such fracture pattern have been reported. The aim is to add data to the scarce pre-existing literature and to discuss management guidelines. Case summary: We hereby present a case report of a 5 year old child who sustained a road traffic accident, injuring his right elbow. The X-ray revealed intercondylar fracture of distal humerus (High T type) with comminution of the olecranon fossa, the fractured medial and the lateral columns were rotated. Open reduction and internal fixation was performed using posterior approach. The medial and the lateral columns were reduced to the shaft and fixed with K-wires. The condyles were then fixed to each other using a transversely placed threaded K-wire. Above elbow slab was given to the patient for 4 weeks. The slab was then removed and elbow range of motion exercise started. Results: After one year of follow up, the Range of motion of elbow was 10 degrees to 130 degrees and no deficit in supination or pronation as compared to the contralateral side. Conclusion: Intercondylar fracture humerus is a rare injury in children. Proper radiograph including oblique views should be taken to prevent misdiagnosis. These fractured are to be managed by open reduction and internal fixation using K-wires for better results.

Study of functional outcome of intercondylar fracture of distal humerus in adults treated with distal humerus locking plate

This study is done to evaluate the functional outcome of intercondylar fracture of distal humerus in adults treated with distal humerus locking plate. Material and Methods: This study is prospective postoperative evaluation of 20 patients with distal humerus fracture (Close and Open grade 1 and Intra-articular distal humerus fracture type B and C) who were treated with Open reduction and internal fixation with plating. Results: All patients treated with open reduction and internal fixation with plate using posterior approach to elbow with olecranon osteotomy, achieved union by end of 6 months. Mayo elbow performance score at final 9 months were noted as excellent (more than 90) in 12(60%) patients, good (75-89) in 4 (20%) patients, fair (60-74) in 3 (15%) patients, and poor(less than 60) in 1 (5%) patient. Few complications like elbow stiffness in 2 patients, superficial infections in 3 patients, 1 case of ulnar nerve neurapraxia were noted which were treated conservatively. There were no major complications. Conclusion: The distal humerus intraarticular fracture of humerus can be managed effectively by operative management. The surgical method requires anatomic reduction and stable and rigid fixation with reconstruction of articular congruity and also requires post-operative early mobilisation, which is a must for good outcome.

Outcome of Dual 90-90 Plating in Intercondylar Fractures of Distal Humerus in Adults

Background: Intercondylar fracture of distal humerus are very difficult to manage. It needs proper anatomic reconstruction and rigid fixation.
 Aims and Objectives of study: Evaluation of outcome of dual bicolumnar 90-90 plating of AO type 13C fractures of distalhumerus in adult.
 Material and method: In a prospective hospital based study on 16 patients with a mean age of 33.37 years ± SD8.30, who presented with intercondylar fracture of distal hummers were studied between July 2015 to December 2017. All patients were graded according to AO classification. Out of 16 patients 5 were in 13C1, 6 were in 13C2 and 5 were in 13C3 subgroup. All patients underwent open reduction through Chevron olecranon osteotomy and fixation was done with dual plating in 90-90 fashioni.e.; 3.5 reconstruction plate posterior and 1/3 tubular plate from medial border. We used the Mayo elbow performance score system for evaluating our results.
 Results: The mean follow up period was 9.38 months. All fractures healed uneventfully. Two of five patients with 13C3 fractures and two of six patients with 13C2 fractures has flexion deformity of less than 30*. Average range of motion was 95*(range 60*-130*). The Mayo elbow performance score was excellent in 7, good in 7 and fair in 2 patients.
 Conclusion: Dual 90-90 plating technique through Chevron olecranon osteotomy is a good method for intercondylar reconstruction with rigid fixation like AO 13C fractures.

Clinical profile of patients with distal humerus intercondylar fractures

Inter-condylar fracture of the distal humerus is uncommon injuries and is difficult and challenging fracture for treatment. Restoration of the articular surface of distal humerus must be nearly perfect and sufficiently rigid to permit early mobilization of the elbow if the results is to be satisfactory. This was a prospective study of 20 cases of intercondylar fracture of distal humerus in adults admitted to medial trust hospital. In our series of 20 cases, there were 9 males and 11 females with average of 44.1 years. 9 cases were due to direct fall and 11 road traffic accident, with predominance of left side (11). Out of 20 cases 5 (25%) were of RR type II, 12 (60%) were of RR III and 3 (15%) were of RR IV.

Study of intercondylar fractures of the distal humerus treated with 90-90 plating

Intra articular fractures of the distal humerus cause considerable morbidity to the patients. There are several controversies regarding the approach and fixation of the fracture. AO advocated 90-90 plating of both columns while recent biomechanical studies demonstrated superior mechanical strength with parallel plating. But parallel plating is associated with many complications. We performed bicolumnar perpendicular plating in 15 intraarticular AO type C fractures through transolecranon approach. Ulnar nerve was isolated and carefully protected, but ulnar nerve transposition was not done. We achieved union in all cases with functional range of movement in 13 patients. We had no case of post-operatively developed ulnar nerve neuropathy or heterotopic ossification. The average Mayo Elbow Performance Score was 85 points. We infer that 90-90 plating is effective in intercondylar fractures of distal humerus with minimal complications.

To study the outcome of intercondylar fractures of distal humerus using dual plating and its functional outcome

To study the outcome of intercondylar fractures of distal humerus using dual plating and its functional outcome

To study the outcome of intercondylar fractures of distal humerus using dual plating and its functional outcome

Introduction: Distal humeral fractures account for approximately 2%–6% of all fractures and for approximately 30% of all elbow fractures [1]. The complex anatomy of the distal end of the humerus, with its unique orientation of articular surfaces supported by a meager amount of cancellous bone, makes its fracture a constant challenge to orthopaedic surgeons [2]. Materials and Methods: A prospective study was conducted in Tertiary hospital for a period of 1 year. We studied 25 consecutive patients with distal humerus intercondylar (AO Type C) fracture, included in study as per inclusion criteria. Discussion: Regardless of the method of treatment, substantial damage to the distal humerus usually results in some limitation of motion, pain, weakness, and possibly instability. Even minor irregularities of the joint surface of the elbow usually cause some loss of function. This can usually be minimized by early, accurate open reduction with sufficiently rigid fixation to permit immediate motion. Conclusion: Delay in open reduction internal fixation with delayed soft tissue dissection leads to increased chances of elbow stiffness due to periarticular fibrosis. Use of conventional plates will suffice and more importance should be given to achieve good intercondylar reduction and pillar reconstruction.

Comparison of treatments in patients with distal humerus intercondylar fracture: a systematic review and meta-analysis

Introduction: Distal humerus intercondylar fractures are intra-articular comminuted fractures of the elbow that involve soft tissue injury. We evaluate different surgical approaches and elbow functional outcomes in the treatment of distal humerus fracture.Materials and methods: Medline, Cochrane, EMBASE, Google Scholar databases were searched up to 29 July 2016. All studies had to have evaluated the treatment of patients with intercondylar fractures of the distal humerus. The primary outcome was the incidence of functional grading of excellent/good.Results: The methods used to evaluate elbow function were diverse across the studies and included non-surgical, fixation and plating approaches. The most common surgical technique used was olecranon osteotomy (n = 7) and triceps-sparing (n = 5). In general, most procedures were associated with >70% of patients having excellent/good joint function following surgery. The meta-analysis included four studies with 276 patients, and compared olecranon osteotomy with triceps-sparing. The pooled analysis indicated that patients treated using olecranon osteotomy had better functional outcome than patients treated with triceps-sparing (pooled OR = 2.38, 95%CI: 1.25–4.55, p = .009).Conclusions: This study found that a wide range of surgical procedures were effective in treating most patients with distal humerus intercondylar fractures, and that the approach of olecranon osteotomy may be more effective than that of triceps-sparing in restoring joint function.Key messagesMost procedures in treating distal humerus intercondylar fractures were associated with >70% of patients having excellent/good joint function following surgery.The most common surgical technique used in treating distal humerus intercondylar fractures were olecranon osteotomy and triceps-sparing.The pooled analysis indicated that patients treated using olecranon osteotomy had better functional outcome than patients treated with triceps-sparing.

Stabilization of Distal Humerus fractures by precontoured bi-condylar plating in a 90-90 pattern

Introduction: The treatment of fractures of the distal humerus is difficult and involves the risk of bad functional results, particularly with articular fractures or impaired bone quality. Anatomical reconstruction and rigid fixation allowing early mobilization of the elbow are the basic prerequisites for good clinical outcomes. The aim of our study was to evaluate outcome of intercondylar fractures of distal humerus. Patients and methods: The study included prospective or retrospective analysis of 28 cases of intercondylar fracture of distal humerus. There were 3 C1, 15C2 and 10 C3 type of fractures as per AO classification in our study. Patients were operated by 90-90 plating using olecranon osteotomy or Campbell’s approach. Results were evaluated by post-operative X-rays, mayo elbow performance score and range of motion measurements. Results: Male to female ratio in our study was 1.15:1. Mean age in study was 41.3±17.0 yrs. Most common mode of injury was fall from height followed by road traffic accident. Mean duration of interval between injury and surgery was 7.1±7.3 days and mean duration of hospital stay was 10.3±6.1 days. 85.72% of patients in had excellent to good results. Mean range of motion in our study was 100.6±20.0 degrees. Complications included 1 case of transient ulnar nerve neuropathy, one case of deep infection, one case of malunion, and one case of delayed union. Conclusions: Open reduction and internal fixation with 90-90 plating provides reliable, rigid fixation allowing early functional mobilization of the elbow joint. Distal humeral locking plates proved to be useful in C3 type of fractures and in elderly osteoporotic bones. Complication rates in the study were low and comparable to studies in literature.

Outcome after internal fixation of intraarticular distal humerus (AO type B & C) fractures: Preliminary results with anatomical distal humerus LCP system.

The treatment of intraarticular fractures of the distal humerus is challenging and involves the risk of complications and bad functional results. Anatomical and stable internal fixation with early postoperative mobilization is expected to improve the functional outcomes. The objective of this study was to evaluate the functional and radiological results, along with the complications associated, of open reduction and internal fixation using precontoured anatomical locking LCP plate system for intraarticular distal humerus fractures in adult patients. This prospective study consist of 31 patients with a mean age of 41.2 years (range 19-62) were treated with open reduction and angular stable internal fixation. All underwent posterior transolecranon surgical approach. Mean follow-up to the final interview was 10 months (from 6 to 20 months). All operated patients were available at the time of last followup. AO classification showed 26 C-fractures (9*13C 1, 12*13C2,5* 13C3) and 5 B-fracture (1* 13B1,1* 13B2,3* 13B3). There were 25 closed fractures and 6 open grade 1 fractures. The clinical followup using Mayo elbow performance score (MEPS) and radiographic follow up with elbow anterior-posterior and lateral view X-rays were performed postoperatively. The mean MEPS was 87.9 points out of 100 (range 55-100) with 61% Excellent, 29% good and 10% fair and poor scores. Mean elbow flexion of 115.8° (range 85°-150°). The mean deficit in extension was 19° (range 5°-35°). All olecranon osteotomy were united .Nonunion of distal humerus fracture occurred in 2 cases. Other complications were hardware prominence in 3 cases, superficial infection in 4 cases and Ulnar nerve neuropraxia in 1 case which was recovered uneventfully. Revision surgery was not required in any complication. Open reduction and internal fixation with precontoured distal humerus anatomical locking plate system is a good method of treatment for complex Supra- intercondylar fracture of distal humerus with good functional outcome and low rates of complications. Even though early results are promising, longer term investigations and larger patient groups are necessary to confirm the presented data.

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

Intercondylar fracture of the distal humerus are uncommon injuries and present the most difficult challenge of the fracture of lower end of humerus. Restoration of the articular surface of distal humerus must be nearly perfect and sufficiently rigid to permit early mobilization of the elbow if the results is to be satisfactory. This is a prospective study of 20 cases of intercondylar fracture of distal humerus in adults admitted to hospital, between august 2011 to September 2013. Cases were taken according to inclusion and exclusion criteria i.e. with intercondylar fracture distal humerus above the age of 18 years and fit for surgery. Medically unfit and not willing for surgery were excluded from the study. Good results seen in 8 cases, fair results in 9 cases and poor results in 3 cases. There were 2(10%) cases each of superficial infection, implant failure, ulnar neuropathy and one (5%) case of non- union and they treated accordingly. Operative treatment with rigid anatomical internal fixation. Should be the line of treatment for all grades of riseborough radin internal fracture as it gives best chance to achieve good elbow function.

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

A study of surgical management of intercondylar fractures of distal humerus in adults using pre-contoured locking compression plate through trans-olecranon approach

Introduction: Intercondylar fractures of distal humerus are uncommon injuries and present the most difficult challenge among fractures of lower end of humerus. Distal humerus fractures with intra-articular extension are complex injuries that require meticulous approach for fixation. The principle involves anatomical reduction and absolute fixation with perfect stabilization of extra osseous implants. The functional outcome has been greatly influenced by the early graduated rehabilitative exercise. Aim and Objectives: The Aim of the present study is to evaluate the Functional Outcome of Surgical Management of Intercondylar Fractures of distal humerus in Adults by Open Reduction and Internal Fixation using pre-contoured locking compression plates through trans-olecranon approach. Material and Methods: Prospective study includes 20 Adult patients with intercondylar fracture of distal humerus admitted to KVG Medical College, Sullia between the periods January 2014 to January 2016 satisfying inclusion criteria. Results: In this study of 20 cases, there were 10 males and 10 females with average of 50.8 years. 12 cases were due to RTA and 8 due to direct fall. There was a predominance of left side (13). Out of 20 Cases, 3 (15%) were of B1 type, 1 (5%) were of type B2, 6 (30%) were of C1, 5 (25%) of C2 and 5 (25%0 were of type of C3. Excellent results in 12 (60%), good in 4 (20%), fair in 3 (15%) and poor results in 1 (5%) case, according to MEPS. Conclusion: Anatomically pre-shaped distal humerus locking plate system is useful in providing stable fixation for complex distal articular fracture and facilitating early postoperative rehabilitation. Clinical and radiological results show good healing rate with good range of motion.

Triangular Fixation Technique for Bicolumn Restoration in Treatment of Distal Humerus Intercondylar Fracture.

BackgroundDistal humerus intercondylar fractures are intra-articular and comminuted fractures involving soft tissue injury. As distal humerus is triangle-shaped, parallel plating coupled with articular fixation would be suitable for bicolumn restoration in treatment of distal humerus intercondylar fracture.MethodsThis study included 38 patients (15 males and 23 females) who underwent olecranon osteotomy, open reduction and internal fixation with the triangle-shaped cannulated screw and parallel locking plates (triangular fixation technique). Functional results were assessed with the visual analog scale (VAS) scores, Mayo elbow performance (MEP) scores and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires. Anteroposterior and lateral elbow radiographs were assessed for reduction, alignment, fracture union, posttraumatic arthrosis, and heterotopic ossification, and computed tomography (CT) scans were used to obtain more accurate measurements of articular discrepancy.ResultsAll fractures healed primarily with no loss of reduction. The mean VAS, MEP, and DASH scores of the affected elbow were not significantly different from those of the unaffected elbow (p = 0.140, p = 0.090, and p = 0.262, respectively). The mean degree of flexion was significantly lower in the affected elbow than in the unaffected elbow, but was still considered as functional (p = 0.001, > 100° in 33 of 38 patients). Two cases of articular step-offs (> 2 mm) were seen on follow-up CT scans, but not significantly higher in the affected elbow than in the unaffected elbow (p = 0.657). Binary logistic regression analysis revealed that only Association for Osteosynthesis (AO) type C3 fractures correlated with good/excellent functional outcome (p = 0.012). Complications occurred in 12 of the 38 patients, and the overall reoperation rate for complications was 10.5% (4 of 38 patients).ConclusionsTriangular fixation technique for bicolumn restoration was an effective and reliable method in treatment of distal humerus intercondylar fracture. This technique maintained articular congruency and restored both medial and lateral columns, resulting in good elbow function.