Intercondylar Fractures Research Articles

Comparative analysis of two double-plate fixation techniques for intercondylar fractures of the distal humerus

This study was aimed to compare the clinical and radiographic outcomes of patients with intercondylar fractures of the humerus treated with orthogonal and parallel plating methods via precontoured plates. This was a retrospective comparative study conducted on 50 adult patients with intercondylar humerus fractures that were surgically treated over an eleven-year period. The patients were divided into two groups: Group A underwent internal fixation via parallel plating, whereas Group B received orthogonal plating. Clinical outcomes were evaluated via the Mayo Elbow Performance Score (MEPS), and the radiographic assessments included time to consolidation, pseudoarthrosis, malunion and hardware removal. Both groups presented similar demographic and preoperative characteristics. The functional outcomes assessed by the MEPS were not significantly different between the groups. Radiographically, comparable healing times and rates of complications, including pseudoarthrosis, malunion and hardware removal, were observed. The study findings suggest that both orthogonal and parallel plating methods yield comparable clinical and radiographic outcomes in the treatment of intercondylar humerus fractures. These results underscore the effectiveness of both techniques and emphasize the importance of further research to elucidate the optimal plating method for specific fracture patterns.

Evaluation of The Treatment of Open Intercondylar Fracture Distal Femur by Transosseous Osteosynthesis Technique with Ilizarov External Fixator

Objectives: Treatment of Distal femoral fractures cannot be done following simple set of rules and when it is an open fracture the treatment is more difficult. Several methods were studied by different authors both at home and abroad, but none were conclusive. Methods: This prospective study was done between January 2011 to December 2012, 15 patients of the open intercondylar fractures of Distal femur were treated by transosseous osteosynthesis technique by Ilizarov External Fixator in NITOR (National Institute of Traumatology and Orthopaedic rehabilitation), Dhaka. 2 of the patients were not available for final follow up after removal of the fixator frame. So ultimately the final result based on the results of 13 Cases. Minimum 6 months follow up was done from the date of injury. No patient below age 16, no type IIIB or IIIC fractures and no patients having less than 6 months follow up were included in the study. Patients with severe injuries (Head injury, Abdomen and chest injury) were excluded from the study. Patients with medical illness such as Diabetes Mellitus, Peripheral Vascular diseases were not included in the study. Results: 12 male and 01 female patient between 16 and 56 years were studied. Most common age group in this series were 16-30 year age group (53.85%) and average age of the patients was 31.15 years. Most of the patients were male and road traffic accident was the leading cause of injury (92.31%). Right side involved in (69.23%) most of the cases. All patients were C3 type of fractures and G-II and G-IIIA types were same (38.46%). Most of the patients (53.85%) were operated within 1-2 weeks of admission. Average duration of hospital stay was 22 days ranging from 10 day to 45 days. Most of the patient had soft tissue healing by granulation tissue formation. Others were treated by primary closure, Delayed primary closure or secondary closure. Various complications were observed among them pintract infection, wire breakage, wire loosening, stiffness of joints, angulations and rotations, deep infection of the tissue, leg length discrepancy was observed in this study. According to the criteria of Neer et al, 1967 final results of the treatment were analyzed. Acceptable result was found in 61.54% of cases (Excellent 7.69% and good 53.85%). Results of the rest of 38.46% cases were not acceptable (Fair 23.08% and poor 15.38%). The result is similar with others done for open fractures of distal femur by Ilizarov External Fixator or other methods of fixation. Conclusion: So it can be concluded that transosseous osteosynthesis technique is a satisfactory method for treating open intercondylar fracture of distal femur as a primary and definite mode of treatment.

Clinical outcomes of triceps reflecting anconeus pedicle and olecranon osteotomy approach for distal humerus intercondylar fractures.

The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation. While there is consensus about the posterior approach, several posterior approaches have been developed. It is debatable as to which approach is best. To compare triceps reflecting anconeus pedicle (TRAP) and olecranon osteotomy approaches for internal fixation of distal humeral intercondylar fracture. In total, 40 cases of Arbeitsgemeinschaft für Osteosynthesefragen/Association of the Study of Internal Fixation type C, closed, and Gustilo type I intercondylar humeral fractures were included. Patients ranged in age from 18 years to 70 years. The patients were randomized into two groups: TRAP group and olecranon osteotomy group, with 20 cases in each. All were followed up at 6 wk, 3 months, 6 months, and 12 months. Functional outcomes were measured in terms of flexion-extension arc, Disabilities of Arm, Shoulder and Hand score, and Mayo Elbow Performance Score. The mean age was 43.2 years in the TRAP group and 37.5 years in the olecranon osteotomy group. The mean operative time and mean duration of hospital stay in the TRAP group were significantly higher than in the olecranon osteotomy group (119.5 vs 111.5 min and 9.85 vs 5.45 d, respectively). The mean arc of flexion-extension, Disabilities of Arm, Shoulder and Hand score, and Mayo Elbow Performance Score were comparable without any significant difference in the groups at the 12-month follow-up (107.0 vs 106.2, 18.3 vs 15.7, and 84.2 vs 86.2, respectively). Ulnar paresthesia and superficial infections were comparable in both groups (2 cases vs 3 cases and 3 cases vs 2 cases, respectively). Hardware prominence was significantly higher in the olecranon osteotomy group, mostly due to tension band wiring. Both approaches were equivalent, but there is a need for further study including higher numbers of subjects and longer study duration to prove the benefits of one approach over the other.

Arthroscopic treatment of femoral trochlear notch fracture caused by intra-articular dislocation of the patella

This case report presents a traumatic intra-articular patellar dislocation – associated intercondylar fracture of the distal femur – and the consequent arthroscope assisted reduction and percutaneous screw fixation. To the best of our knowledge, this is the first case in which the arthroscope assisted operative reduction and percutaneous screw fixation of the fracture fragment has been demonstrated. Our patient was a 55-year-old female who was treated by the aforementioned method which concluded with excellent results.

Outcomes of total elbow arthroplasty in the treatment of distal humeral fractures in the elderly: a retrospective cohort comparison between primary arthroplasty and arthroplasty secondary to failed internal fixation

BackgroundThe primary objective of this study was to compare the clinical outcomes of total elbow arthroplasty as the index procedure in the treatment of traumatic distal humerus fractures, with secondary total elbow arthroplasty following failed internal fixation. The secondary objectives were to compare the complication rates and the radiographic results in the two groups. Our hypothesis was that the clinical results of total elbow arthroplasty performed secondarily to failed internal fixation were comparable to primary total elbow arthroplasty in the treatment of distal humerus fractures in the elderly population. MethodsWe conducted a retrospective cohort comparison study, including 60 patients with a median age of 80 years (71-85), who either underwent a primary total elbow arthroplasty (group 1; 45 patients), or secondary total elbow arthroplasty following failed internal fixation (group 2; 15 patients), in the treatment of a post-traumatic supra and intercondylar fracture of the distal humerus, between January 2004 and January 2021. The clinical examination, including MEPS score and triceps proficiency test, complication rates and the need for re-operation were noted. The average clinical and radiographic follow-up was 40.8 months (24-120). ResultsThe clinical results of the two groups were comparable when looking at the MEPS score (90.00 [85.00, 100.00] p= 0.486). With regards to complications, there were 2 surgical site infections in group 1 and 3 in group 2 (p=0.099), 1 case of mechanical loosening of the humeral component in group 1 and 1 in group 2 (p= 0.448), and 1 patient with triceps insufficiency in group 1. ConclusionSecondary total elbow arthroplasty following failed internal fixation has shown good functional results, and a complication rate comparable to that of index total elbow arthroplasty in the treatment of articular fractures of the distal humerus in the elderly.

Results of Surgical Treatment of Intercondylar Fractures of the Humerus in Adults by Double Plate Technique

Results of Surgical Treatment of Intercondylar Fractures of the Humerus in Adults by Double Plate Technique

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.

Precontoured anatomical plate fixation is not superior to recon plate fixation for intercondylar fracture humerus in adults

Abstract Introduction: Intercondylar fractures are intraarticular distal humerus fractures that are frequently linked to osteopenia, comminution, and displacement. Due to its intricate anatomy, fractured bone frequently consists of many fragments and has few fixing possibilities. Open reduction and internal fixation (ORIF) is the best treatment option for these fractures, most commonly either with precontoured anatomical locking plates or recon plates. This study aims to compare the functional and radiological outcomes and rate of complications in the management of intercondylar fracture of the humerus with recon plates and precontoured anatomical plates. Materials and Methods: We have prospectively evaluated the outcome of precontoured anatomical plate vs recon plate fixation in the management of adult intercondylar fracture of the humerus in 20 patients having 10 patients in each of the groups. The study was done between November 2020 and November 2022. The recon plate group was designated as group 1 and the precontoured anatomic plate group as group 2. Orthogonal plate fixation was done in both groups. Ulnar nerve transposition was not done in any case. The study included seven patients of AO13C1, eight patients of AO13C2, and five patients of AO13C3 type of intercondylar fracture of the humerus. The mean follow-up period was 8.4 months. The functional outcome was assessed by the Mayo Elbow Performance Scoring (MEPS) system and the radiological outcome was by elbow anteroposterior/lateral radiographs. The minimum follow-up duration was 6 months. Results: In both groups, the average duration of operation and hospitalization was comparable. At 3 months follow-up after surgery, the mean MEPS in the locking precontoured anatomical plate group (group 2 = 82) was significantly higher than that of the traditional recon plate (group 1 = 69.50; P = 0.026). However, the mean MEPS was comparable in both the study groups (group 1 = 81.50, group 2 = 88, P = 0.154) at 6 months after the surgery. Range of motion (ROM) was comparable for each study group after 3 months and final follow-up as well. The patients in group 2 took much less time to achieve union than the patients in group 1 (P = 0.001); however, in total 95% of the study patients achieved union. The rate of complications including wound infection, tension band wire backout, implant loosening, and joint stiffness was similar in both groups. Conclusion: Precontoured anatomical plates and recon plates did not significantly differ in the functional results of distal humeral fractures (AO type 13C), including the ROM and MEPS at a mean follow-up duration of 8.4 months; however, there was a considerable variance in the union time, in which patients operated with precontoured anatomical plates showed much less time to achieve union than the recon plates.

Neglected upper-extremity fractures at a severe trauma center in the Republic of Korea

Purpose: Missed injuries and delayed diagnoses are likely when diagnosing patients with severe trauma. This research aimed to investigate the incidence of missed fractures in the upper extremities by retrospectively analyzing factors leading to an overlooked diagnosis.Methods: We retrospectively investigated patients hospitalized with newly diagnosed upper-extremity fractures after an initial diagnosis at Severe Trauma Center of Pusan National University Hospital. We analyzed the accompanying injuries, Injury Severity Score (ISS), reasons for a missed diagnosis, and treatment results.Results: Twenty-four patients and 27 cases were identified. The incidence of fracture was 0.4%, and the average diagnostic period was 33 days. The mean ISS was 24.3. Among the 27 cases of neglected fractures there were 1 intercondylar fracture of the humerus, 11 were radial or ulnar forearm fractures , six were carpus or metacarpal fractures, and nine were phalangeal fractures. Among the 24 patients with a delayed diagnosis, 21 patients had orthopedic-related fractures at other sites at the time of initial diagnosis. There were 12 cases of fracture in the ipsilateral limb. At final follow-up, 15 patients exhibited <50% of normal range of motion in the injured area.Conclusion: A neglected upper-extremity fracture can result in missing the optimal surgery window and rehabilitation period, culminating in poor outcomes. Therefore, an orthopedic surgeon must conduct repeated, careful physical examinations with appropriate consideration of the injury mechanisms.

Nonvascularized fibular graft with locking screw fixation for metaphyseal bone loss of distal femur: biomechanical assessment validated by a clinical case series.

The optimal modality to surgically treat significant bone loss of distal femur remains inconclusive. The objectives of the present study were to assess the mechanical performance of nonvascularized fibular graft (NVFG) with locking screw fixation in distal femur fixation construct by finite element analysis and to retrospectively describe the outcomes of the present technique in clinical cases. Four constructs which the fractured femur was stabilized by LCP-DF alone, dual plating, LCP-DF combined with NVFG, and LCP-DF combined with NVFG (LCP-DF-NVFG-S)with locking screw were assessed the biomechanical performance under physiological loads. For the clinical case series, 12 patients with open intercondylar fracture with metaphyseal bone loss of distal femur were operated by LCP-DF-NVFG-S. The collected data included fracture consolidation, length of NVFG, perioperative complications and objective clinical results. LCP-DF-NVFG-S demonstrated lower implant equivalent von Mises stress (EQV) stress and better fracture stability than other constructs. A locking screw presented its essence in maintaining the NVFG in the required position and subsequently enhancing the fracture stability. In regard to the clinical series, all fractures were consolidated with an average duration of 27.8weeks (range 20-32). An average NVFG length was 7.8cm (range 6-12). No perioperative complication was demonstrated. By the Knee Society score, 1 was considered to be excellent, 9 to be good and 2 to be poor. Based on the results of mechanical assessment and case series, LCP-DF-NVFG-S can be an effective technique in the management of metaphyseal bone loss of distal femur.

Risk factors of elbow stiffness after open reduction and internal fixation of intercondylar fracture of humerus

To investigate the risk factors of elbow stiffness after open reduction and internal fixation of intercondylar fracture of humerus. From March 2015 to February 2019, 120 patients with humeral intercondylar fractures were treated with open fixation including 59 males and 61 females, aged from 25 to 77 years with an average of(53.5±3.2) years. According to the occurrence of elbow stiffness after operation, 120 patients were divided into stiffness group(37 cases) and control group(83 cases). The related factors of elbow stiffness were analyzed by single factor analysis, and the risk of elbow stiffness after internal fixation of humeral intercondylar fracture was analyzed by logistic regression factor. There were 37 cases of elbow stiffness(stiff group), and 83 cases had no elbow stiffness(control group). The incidence of joint stiffness was 30.83%. There were significant differences between the stiffness group and the control group in age, injury energy, fracture to operation time, AO classification of fracture, open injury and postoperative premature or hyperactivity. Multivariate logistic regression analysis showed that age>50 years old, high energy injury, AO classification of fracture, open fracture and postoperative premature or hyperactivity were risk factors for elbow stiffness after internal fixation of humeral intercondylar fracture. The postoperative mobility and Mayo elbow performance score(MEPS) scores of the postoperative stiffness group were lower than those of the non-stiffness group with statistical significance(P<0.05). There were no significant differences in postoperative mobility and MEPS scores between flexion stiffness and rotation stiffness after humeral intercondylar fracture(P>0.05). In view of the risk factors of elbow stiffness after internal fixation of humeral intercondylar fracture, reasonable operation plan and rehabilitation strategy should be formulated before operation to minimize the incidence of elbow stiffness.

Percutaneous elevation of radial head fractures without fixation - a promising technique.

The aim of the study is to describe the surgical technique and to report the outcomes of triceps reflecting anconeus pedicle (TRAP) approach for intercondylar fractures of the humerus. Twenty two patients with intercondylar fractures of the humerus were operated on by open reduction via the TRAP approach and internal fixation with dual precontoured locking plates. Data were collected on union time, postoperative complications, range of motion (ROM), triceps power, and objective clinical measurement. All fractures were united with a mean union time of 16.5 weeks (range 12-22). All patients had good-to-excellent Mayo Elbow Performance (MEP) score results with a mean ROM of 118.2 degrees (range 90-135). Triceps power was grade 5 in 16 patients and grade 4 in 6. There were 3 transient ulnar nerve palsy and 1 heterotopic ossification. TRAP approach is safe and effective in terms of utility for articular reduction, restoration of elbow motion, and triceps function for intercondylar fractures of the humerus.

Lateral Approach for Distal Articular Fractures of Humerus in Canines-A Review of 4 Cases

Background: Humeral condylar fractures have fracture lines that extend through the joint surface and through one or both epicondyles or epicondylar crests, or into the distal shaft. Addressing the distal articular Humeral fractures in dogs through lateral approach by using positional transcondylar screws. Methods: A total of four cases of dogs with different age groups, breeds and sex with fore limb lameness caused due to trauma were included in the study. Clinical and standard radiological examination of all revealed intercondylar fractures with reduced range of motion where the fracture of the condyle extending from the articular surface. After preoperative evaluation all the animals were subjected to surgical reduction by lateral approach under general anaesthesia using positional transcondylar screws (n=2) with or without K-wires in cross fashion (n=2). This approach avoided the necessity of olecranon osteotomy and triceps tenotomy with their associated complications. Result: Excellent limb utility was obtained during postoperative period by clinical and radiographical grading system. To conclude, the use of fully threaded cortical screws was found effective for surgical management of distal humeral condylar fractures in dogs via lateral exposure.

Clinical and Functional Outcomes of Anatomical Plating in Distal Humerus Fractures in Adults.

Background Overall, 2% of all adult fractures are attributed to fractures of the distal humerus, including both supracondylar and intercondylar fractures. According to recent studies, stable fixation with anatomical reduction of intra-articular fragments and early mobilization is required for best outcomes. This study included patients with distal end humerus fractures treated by open reduction and internal fixation (ORIF) with anatomical locking plates and evaluated their clinical outcomes. Methodology This prospective study was conducted at a medical college teaching hospital in southern Rajasthan, India. In total, 20 adult patients with distal end humerus fractures who presented to the orthopedic outpatient department or casualty were admitted. Patients were treated by ORIF with anatomical locking plates, followed up, and evaluated for clinical and functional outcomes. Results Using the Mayo Elbow Performance Score, out of 20 cases, excellent results were noted in five patients, good results in seven patients, fair results insix patients, and poor results in two patients. Conclusions Locking plates are reliable and effective management options for distal humerus fractures. As locking plates are strong and rigid, the period of immobilization can be decreased. Early mobilization helps in preventing joint stiffness and fixed deformity of the joint.

Study of outcome of distal humerus fracture treated with plating

Background and Aim: Bicondylar intraarticular fractures of the distal humerus, because of their rarity and often associated significant displacement, comminution, and osteopenia, present the orthopaedician with a difficult injury to treat successfully. But modern techniques of open reduction and internal fixation provide stable construct to allow early post-operative motion without compromising bone healing. The aim of the present study is to evaluate the functional outcome of surgical management of the distal humerus with extra and intraarticular extension in adults using plating.Material and Method: A total of 20 patients were included in the study. All the included patients had fractures of the distal humerus, aged >18 during the period of 2020-2021 in our hospital. Fracture is classified according to AO-OTA Classification. All are treated by open reduction and plating. Length and type of plate were selected as per fracture pattern. Post-Operatively above elbow cast was given to decrease pain and edema. The patients are followed up at regular intervals of 4,8,12 and 16 weeks and results were evaluated using the Mayo Elbow Performance Score for the results of treatment.Results: We had 25% excellent, 50% good results, 10% fair & 15% poor results.Discussion and Conclusion: Open reduction internal fixation should be done as early as possible. Delay in open reduction internal fixation with delayed soft tissue dissection leads to increased chances of elbow stiffness due to periarticular fibrosis. For a successful internal fixation of the closed distal humeral fracture, it is necessary to maintain anatomic and stable reconstruction of the articular surface and of both humeral columns using two 90-90° plates. Operative treatment with rigid anatomical internal fixation should be the line of treatment for all grades of extra and Intercondylar fractures, more so in young adults, as it gives the best chance to achieve good elbow function.

Three-dimensional fracture mapping and analysis of coronal fractures in AO/OTA types 33-B3 and C3

BackgroundAlthough the relatively high incidence of coronal fractures in the supracondylar–intercondylar fractures is well established, little is currently known about the morphology of those fractures. Herein, we characterized the coronal fractures in AO/OTA type 33-C3 and assessed their differences with Busch–Hoffa fractures (33-B3).MethodsWe retrospectively collected 61 cases of AO/OTA type 33-B or C fractures with coronal plane fragments and generated three-dimensional fracture maps of those with coronal fractures based on CT imaging and measured angle α (the angle between the coronal fracture and the posterior condyle axis in the axis plane) and angle β (the angle between the coronal fracture and the posterior femoral cortex in the sagittal plane).ResultsThirty-three cases (32%) of AO/OTA type 33-C fractures contained coronal fragments. Most of them were type 33-C3 fractures. Angles α and β for type 33-C3 were significantly smaller than for type B3 at the lateral condyle, while the angles at the medial condyle were not significantly different. The fracture maps showed that the coronal fractures and the articular comminution area were more anterior in type 33-C3.ConclusionsThe incidence of coronal fractures was 32% and 67% in AO/OTA types 33-C and 33-C3, respectively. Our findings suggest that coronal fractures differed between both types, emphasizing the potential need for different treatment approaches.

Treatment of Pediatric Intercondylar Humerus Fracture With External Fixation and Percutaneous Pinning After Closed Reduction.

BackgroundIt is uncommon for young children to suffer an intercondylar fracture of the distal humerus. Although many approaches have been described to manage, there is no specific and accepted treatment protocol for such fracture patterns. This study aimed to identify the incidence of intercondylar fracture of the distal humerus in the pediatric population and report the clinical outcome of external fixation and percutaneous pinning in such injury patterns.MethodsPediatric patients under the age of 14 years who had an intercondylar fracture of the distal humerus treated with external fixation and percutaneous pinning between January 2013 and December 2018 at the author’s Wuhan Union Hospital were retrospectively evaluated. The detailed baseline information of the patients, operating time, time to union time, and carrying angle difference (CAD) of the injured extremity were collected. During the follow-up visit, clinical results were evaluated using the Mayo Elbow Performance Score (MEPS) and the Flynn criteria.ResultsA total of eight patients (2 women and 6 men) with an average age of 8 years (5–12 years) who had an intercondylar fracture of the distal humerus (1 C2 and 7 C1) were included. All the patients achieved union, and the average MEPS score was 95 points 24 months after the surgery.ConclusionThe intercondylar fracture of the distal humerus in children is rare, and closed reduction and external fixation is a viable treatment option, especially for the C1 type of fracture pattern.

Treatment of Fracture Distal End Humerus with open Reduction and Internal Fixation with Plate Osteosynthesis

AbstractBackground: Fractures of distal humerus represent one of the most complicated and challenging fractures in the upperextremity. These are rare fractures. Most fractures involve the joint surface, significant proportions are open, and thecomplex three-dimensional geometry of the distal humerus poses a considerable challenge to reconstruction.Objectives: To study the treatment of fracture distal end humerus with open reduction and internal fixation with plateosteosynthesisMethods: A prospective study of 15 consecutive cases of intercondylar fractures of humerus treated by open reductionand internal fixation over two and half years was conducted. These included 12 fresh cases and 3 old cases. Case wisedetailed study was done in 12 cases by noting the age, sex social status, nature of violence and the duration of injury,information regarding medical problems and any local problems, in relation to bone and joint.Results: At follow up, patients were assessed clinically and radiologically, most patients regained fair to good range ofmotion obtained in 3 months time fracture was united in an average of a 10 weeks and olecranon osteotomy in an averageof 8 weeks. Patients were followed up for an average of 9 months, excellent results were found in five cases (33.33%).Good results in five cases(33.33%) and fair results were obtained in three (20%) cases, poor results in two cases(13.33%)Conclusion: Comminuted fractures of distal humerus in the hands of competent surgeon with open reduction, anatomicassemblage and internal fixation of the fragments offer better results in majority of the cases. In young patients the resultsare good and in old patients results fair probably because of good physiotherapy in young and also cartilage changes limitthe functional outcome in the old. Physiotherapy has a great role in the outcome of functional result.

Functional and radiological outcome of C-shaped intercondylar fractures in children.

The aim of this study was to retrospectively evaluate the clinical, functional, and radiographic outcomes of displaced C-shaped intercondylar fractures of the humerus in children and adolescents, and evaluate upper-extremity function with the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH). We retrospectively reviewed the data of nine children with displaced C-intercondylar fractures that were treated surgically. Age, sex, laterality, mechanism of injury, amount of displacement, type of treatment, fixation method, and outcome were recorded. The outcome of C-shaped fractures was compared with that of T-intercondylar fractures published by the same surgeons in a previous study. A total of nine consecutive patients (median age, 12 years; range, 9-14 years) with displaced C-intercondylar fractures of the humerus (3 females) were included; in six cases (67%), the left side was affected. Median follow-up was 2 years (range, 2-6). All patients underwent open reduction and internal fixation by screws ( n = 5), Kirschner-wires ( n = 3), or both ( n = 1). Overall, four out of nine patients developed a total of five complications (55.5%): one case of secondary displacement, one case of fishtail deformity, two cases extension deficit, and one case of limited flexion/extension requiring release. The median Quick DASH score at last follow-up visit was 0 (range, 0-4.5). C-intercondylar fractures should be added as a class to complete the Tnoniolo and Wilkin's classification. The prognosis is similar to that of T-intercondylar fractures because, in both cases, fractures are intra-articular and require open reduction and internal fixation.

Modified pin and plate fixation for low intercondylar fractures of the humerus: biomechanical study corroborated with a case series.

Establishing fracture union of low and comminuted intercondylar fractures of the humerus is inherently challenging. The purposes of the present study were to investigate the biomechanical effectiveness of pin & plate (PP) fixation compared to other dual-plating techniques by finite element analysis, and to present a technical description as well as retrospectively review the outcomes of PP fixation in such difficult fractures. Low-level intercondylar fracture 3D models of the humerus were virtually stabilized with three fixations on lateral side including PP, lateral pre-contoured locking compression plate (L-LCP), and variable angle lateral pre-contoured locking plate (VA-L-LCP) whereas medial pre-contoured locking compression plate (M-LCP) on medial side. Loading conditions under consideration were axial compression, internal rotation, posterior bending, and valgus rotation. Regarding the clinical series, eight patients with intra-articular and comminuted fractures of the distal humerus (6 intercondylar fractures, 1 fracture-subluxation, and 1 isolated lateral condylar fracture) were operated by isolated PP fixation or combinations of PP and the other standard implants. Data were collected on fracture union, perioperative complications, and objective clinical outcomes. Biomechanical results revealed the most instability of the fracture occurring under posterior bending. PP fixation presented comparable fracture stability and fragment displacement compared to other dual-plating fixations, except stress on the Kirschner wire under internal rotation which was higher than other fixations. Regarding the clinical series, fracture union was achieved in all cases with an average union time of 17weeks (range 12-20). All except one patient had good-to-excellent MEPS results with an average Disabilities of the Arm, Shoulder, and Hand (DASH) score of 14.6 (range 0-45) and an average arc of elbow motion of 107.5 degrees (range 60-140). By the biomechanical performance, PP fixation is a reliable technique for fixation of low intercondylar fractures of the humerus. Supported by the clinical outcomes, the present technique could be an alternative for this particular fracture especially when severe comminution prevents the use of the standard dual plating technique.