Intra-articular Distal Humerus Fractures Research Articles

Ligament Sparing Elbow Hemiarthroplasty: A Novel Technique for the Management of Distal Humeral Fractures.

Intra-articular distal humerus fractures present various challenges with a wide array of treatment options. Open reduction internal fixation remains the treatment of choice. In older patient populations with poor bone quality and short-end segment fractures with articular comminution, open reduction internal fixation, however, may bring on unsurmountable technical challenges. Total elbow arthroplasty and elbow hemiarthroplasty (EHA) may offer superior functional outcomes in these cases. During EHA for fractures, the medial and lateral columns are reconstructed with the collateral ligaments to restore elbow stability. We hypothesize that in coronal sheer fracture patterns where the columns are intact, maintaining the native collateral ligaments and columns will provide both an anatomic and stable elbow joint. We introduce the ligament sparing EHA technique for unreconstructible coronal shear fractures. We describe this novel technique and compare our postoperative outcomes in 2 patients who underwent this surgery to those described in the literature. The postoperative Disabilities of the Arm, Shoulder, and Hand scores for the 2 patients were 13.8 and 10.3, respectively. The Mayo Elbow Performance Score for the 2 patients were 80 and 85, respectively. The operative arm presented a grip strength of 82% and 89% when compared with the contralateral arm, for the patients respectively. The range of motion varied between 78% and 100% of the contralateral arm for both patients. Although our results are promising and the ligament sparing EHA technique may be a more anatomic option in certain fracture patterns, further research with larger cohorts and multiple surgeons is needed to reinforce our results.

The importance of interdigitating screw fixation of the trochlea in double plate osteosynthesis of low transcondylar distal humerus fractures: A biomechanical study

ObjectiveThe trochlea is of great importance for the stability of the elbow and its fixation in low transcondylar fractures of the distal humerus is especially challenging. The aim of this study was to determine the optimal trochlea fixation in double plate osteosynthesis of intraarticular distal humerus fractures. MethodsA low transcondylar, C3-type distal humerus fracture was created in 20 fresh-frozen human cadaveric humeri. The samples were then randomly divided into two groups of 10 specimens each. Double plate osteosynthesis was performed in both groups. In group A, the two most distal screws of the lateral plate were inserted into the trochlea fragment. In group B, these screws did not extend into the trochlea. Displacement under cyclic loading and ultimate failure loads were determined for all specimens. ResultsGroup A showed significantly less displacement under cyclic loading in each measurement interval (0.92 mm vs. 1.53 mm after 100 cycles, p = 0 0.006; 1.10 mm vs. 1.84 mm after 1000 cycles, p = 0.007; 1.18 mm vs. 1.98 mm after 2000 cycles, p = 0.008). The ultimate failure load was significantly higher in group A than in group B (345.61 ± 120.389 N vs. 238.42 ± 131.61 N, p = 0.037). ConclusionsFixation of the trochlea with interdigitating screws in double plate osteosynthesis of low-condylar type C distal humerus fractures results in superior construct stability. Level of evidencenot applicable (biomechanical)

Utility of three-dimensional printing in the surgical management of intra-articular distal humerus fractures: a systematic review and meta-analysis of randomized controlled trials.

Clinical outcomes after fixation of distal humerus intraarticular fractures are directly related to the quality of reduction. The use of three-dimensional (3D)-printed fracture models can benefit preoperative planning to ensure good reduction. This review aims to determine if surgery performed with 3D printing assistance are faster and result in fewer complications and improved clinical outcomes than conventional methods. We also outline the benefits and drawbacks of this novel technique in surgical management of distal humerus fractures. A systematic literature search was carried out in various electronic databases. Search results were screened based on title and abstract. Data from eligible studies were extracted into spreadsheets. Meta-analysis was performed using appropriate computer software. Three randomized controlled trials with 144 cases were included in the final analysis. The 3D-printed group had significantly shorter mean operating time (mean difference, 16.25 minutes; 95% confidence interval [CI], 12.74-19.76 minutes; P<0.001) and mean intraoperative blood loss (30.40 mL; 95% CI, 10.45-60.36 mL; P=0.005) compared with the conventional group. The 3D-printed group also tended to have fewer complications and a better likelihood of good or excellent outcomes as per the Mayo elbow performance score, but this did not reach statistical significance. Three-dimensional-printing-assisted surgery in distal humerus fractures has several benefits in reduced operating time and lower blood loss, indirectly decreasing other complications such as infection and anemia-related issues. Future good-quality studies are required to conclusively demonstrate the benefits of 3D printing in improving clinical outcomes. Level of evidence: I.

The "Bag of Bones" Treatment of Comminuted Intra-articular Distal Humerus Fractures in the Elderly.

Extensively comminuted intra-articular distal humerus fractures in the elderly present a challenging therapeutic dilemma. The purpose of this study was to investigate the results of nonoperative treatment of these fractures in a select subset of patients. Patients treated with nonoperative management for a comminuted intra-articular distal humerus fracture between 2007 and 2018 were reviewed. Patients were administered 3 elbow-specific functional outcomes instruments. A total of 8 patients (2 men, 6 women) were treated with brief immobilization followed by early range of motion. All had fractures with extensive comminution of the articular surface such that open reduction and internal fixation was not feasible. Average age was 70 years. At an average of 33 months postinjury, average flexion was 124°, and extension was -27°, with full forearm rotation. No patients required pain medications at the latest follow-up. At 33 months of follow-up, the average Mayo Elbow Performance Score was 92/100 (100 optimal), Oxford Elbow Score was 43/48 (48 optimal), and Quick Disabilities of the Arm, Shoulder, and Hand Score was 10/100 (0 optimal). All patients were satisfied with the nonsurgical treatment that they received. Nonoperative treatment for comminuted intra-articular distal humerus fractures results in acceptable functional outcome in elderly patients and should be considered when the fracture is not amenable to internal fixation and in lower-demand patients with higher surgical risk.

Are olecranon osteotomies preferred to triceps-elevating approaches in intraarticular distal humerus fractures? a literature review

Abstract Background The outdated ‘bag of bones’ concept for managing intraarticular distal humerus fractures (IDHF) has historically given way to precise articular reduction made possible by modern implant designs and the option of joint replacement as a last resort for unreconstructable fractures. Several posterior approaches to the distal humerus have been described since the last century, among which the olecranon osteotomy is considered the most invasive yet the most employed approach in cases of intraarticular distal humerus fractures. Objectives The advantages and reported complications of the triceps fascial tongue approach, the triceps reflecting anconeus pedicle (TRAP) approach, and the olecranon osteotomy in cases of intraarticular distal humerus fractures were the subjects of a thorough literature search in the PubMed, SCOPUS, Cochrane Library, and Google Scholar databases. This literature review made use of all pertinent data.

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.

Impact of the SARS-CoV-2 outbreak on ACGME-accredited orthopaedic trauma fellowship training

IntroductionThe SARS-CoV-2 viral outbreak created unprecedented challenges in surgical education. Yet, its impact on reported case volume during orthopaedic trauma fellowship training remains poorly understood. We hypothesized that cases performed during orthopaedic trauma fellowship training would decrease by 8 %–17 % during the 2019–2020 academic year corresponding to the 1–2 month moratorium of non-essential cases during the initial SARS-CoV-2 outbreak in the United States. MethodsWe designed a retrospective cohort study of orthopaedic trauma fellows at Accreditation Council for Graduate Medical Education (ACGME)-accredited training programs (2018–2019 to 2021–2022). Mean case volumes were compared by case category across academic years. ResultsThere was a −13 % year-over-year decrease in reported case volume during the 2019–2020 academic year (505 ± 126 vs 441 ± 94, P = 0.079, Fig. 1). Case categories with the greatest percentage declines were Treatment of Nonunion / Malunion (−31 %), Fasciotomy (−25 %), External Fixation (−21 %), Forearm / Wrist (−21 %), and Intra-articular Distal Humerus Fracture (−17 %). There was a 7 % year-over-year increase in case volume during the subsequent 2020–2021 academic year with near universal increases in case volume across case categories. ConclusionThere was a 13 % decrease in orthopaedic trauma case volume during the 2019–2020 academic year, corresponding to the SARS-CoV-2 outbreak. Certain trauma case categories experienced the greatest negative impact, which subsequently recovered during the next academic year. These results may help inform accrediting bodies and surgical educators on the impact of future viral outbreaks on orthopaedic trauma fellowship training.

A review on functional outcomes of intra-articular distal humerus fractures treated with recon plate using Mayo Elbow Performance Score (MEPS).

Objective: To Review on Functional Outcomes of Intra-articular Distal Humerus Fractures Treated with Recon Plate Using the Mayo Elbow Performance Score (MEPS). Study Design: Retrospective study. Setting: Department of Orthopaedic &amp; Spine Surgery, Ghurki Trust Teaching Hospital, Lahore. Period: 2015 to 2021. Material &amp; Methods: A total of 353 patients meeting the inclusion criteria enrolled in the study. Patients were followed up at three months postoperatively to assess functional outcome using the Mayo Elbow Performance Score (MEPS). All data were recorded on the proforma. All the collected data were entered and analyzed through SPSS version 22. The chi-square test was applied post-stratification, taking p≤0.05 as significant. Results: In this study, 353 patients were included; among these majority, 220(62.4%) were males, and 133 were female (37.7%). The mean Age of patients was 42.5±14.32, ranging from 18 to 75 years. 182(51.6%) were affected on the left side compared to the right Side 170(48.2%). In most cases, the history of a mode of injury was fall 266(75.3%), and only 87(24.6%) had RTA history. The average MEPS score was 87.37±15.81, ranging from 40 to 100. According to the distribution of functional outcome, 265(75.1%) reported excellent outcome, 52(14.7%) with good, 26(7.5%) as fair, and only 10(2.8%) reported poor outcome. Stratification of functional outcome and patient demographic history showed a statistically significant association between age, gender, side effect, mode of injury, and functional outcome as p&lt;.05. Conclusion: It is concluded that Recon plates provided patients who had distal humerus fractures an excellent functional result. It provides reliable stabilization for fractures of the distal humerus. Due to its improved stability, the device aids early mobility even in fractures with complications. Therefore, the surgeon should use this technique to avoid complications.

Distal humeral hemiarthroplasty compared to total elbow replacement for distal humeral fractures: a registry analysis of 906 procedures

Total elbow replacement (TER) is an accepted treatment for complex intra-articular distal humerus fractures in elderly patients. Distal humeral hemiarthroplasty (HA) is also a potential surgical option for unreconstructable fractures and avoids the concerns regarding mechanical wear and functional restrictions associated with TER. In the current literature, there are limited data available to compare the revision rates of HA and TER for the treatment of fracture. We used data from a large national arthroplasty registry to compare the outcome of HA and TER undertaken for fracture/dislocation and to assess the impact of demographics and implant choice on revision rates. Data obtained from the Australian Orthopaedic Association National Joint Replacement Registry from May 2, 2005, to December 31, 2021, included all procedures for primary elbow replacement with primary diagnosis of fracture/dislocation. The analyses were performed using Kaplan-Meier estimates of survivorship and hazard ratios from Cox proportional hazards models. There were 293 primary HA and 631 primary TER procedures included. The cumulative percent revision (CPR) rate at 9 years was 9.7% for HA (95% confidence interval [CI] 6.0, 15.7), and 11.9% (95% CI 8.5, 16.6) for TER. When adjusted for age and gender, there was a significantly higher risk of revision after 3 months for TER compared to HA (HR=2.47 [95% CI 1.22, 5.03], p=0.012). There was no difference in the rate of revision for patients aged <55 years or ≥75 years when HA and TER procedures were compared. In primary TER procedures, loosening was the most common cause of revision (3.6% of primary TER procedures) and the most common type of revision in primary TER involved revision of the humeral component only (2.6% of TER procedures). TER has a higher rate of 1st revision for loosening compared to HA (HR=4.21(1.29, 13.73); p=0.017). In HA procedures instability (1.7%) was the most common cause for revision. The addition of an ulna component was the most common type of revision (2.4% of all HA procedures). For the treatment of distal humerus fractures, HA had a lower revision rate than TER after 3 months when adjusted for age and gender. Age <55 or ≥75 years was not a risk factor for revision when HA is compared to TER. Loosening leading to revision is more prevalent in TER and increases with time. In HA, the most common type of revision involved addition of an ulna component with preservation of the humeral component.

Adjunctive intraosseous wiring fixation technique for the comminuted distal humeral fractures

Distal humeral fractures are among the most challenging injuries to treat. Although precise repair of the articular surface is essential during surgery, accurate reconstruction of the metaphysis contributes to the overall stability of the fracture construct. The intraosseous wiring technique has been used for small-fragment fractures. However, its efficacy as an adjunct for distal humerus fixation has yet to be thoroughly investigated. This study aimed to demonstrate the applicability of this technique to comminuted, distal humeral fractures. In this retrospective case series, we describe 6 cases of intra-articular distal humerus fractures treated with this technique, followed by dual plating. We observed successful bone union in all patients, with the Mayo Elbow Performance Scores indicating "good" to "excellent" clinical outcomes for this procedure at the final follow-up. We believe that this intraosseous wiring technique should be an integral part of the toolbox of every surgeon because it is a relatively simple and highly effective procedure that requires no special instrument and can be used on various types of fractures.

Functional outcome of intra-articular distal humerus fractures treated with locking compression plates – A prospective study

: To evaluate the clinical and functional outcome of intra-articular distal humerus fractures treated with locking compression plates.: A total number of 25 patients with intraarticular fractures of the distal humerus, from March 2021 to September 2022 were enrolled in the study. All patients were subjected to relevant investigations after which were taken up for surgical fixation of the fracture with bicolumnar distal humerus locking compression plates applied in orthogonal configuration through a posterior transolecranon approach. Patients were followed up at intervals of 6 weeks, 3 months and 6 months for assessing union and the functional recovery at each follow-up.: The study population consisted of 19 men and 6 women with mean age of 43.08±11.89 years. Motor Vehicle Accidents (MVA) were the most common cause of injury accounting for 56% of the cases. Most common fracture pattern was AO 13C2, which was observed in 44% of the cases. Mean duration of the fracture healing was 13.40 ± 1.83 weeks. Mean range of flexion arc was 111.20 ± 14.53 degrees. There were 16 patients with excellent MEPS outcome while six patients had good outcome and three patients had reported fair outcome. There were three cases of joint stiffness though had fair MEPS score. Two cases had superficial skin infection and two cases had reported hardware irritation.: Bi columnar distal humerus locking compression plate is a stable and safe implant for management of intraarticular fractures of distal humerus. The present study shows promising results when the plates are applied in orthogonal configuration through posterior chevron osteotomy approach. A good anatomical fixation allows early mobilization which improves the functional outcome.

Intra-articular distal humerus fracture – TRAP or olecranon osteotomy

: Intra-articular distal humeral fractures can be approached in a variety of ways. The purpose of this study is to evaluate and compare the functional outcomes of two approaches: one with olecranon osteotomy and other with triceps-lifting approach; for the treatment of intra-articular distal humeral fractures.: In this study, 10 patients in Group A were compared with 10 patients in Group B. Both the groups were comparable in terms of age, gender, duration of injury and degree of comminution of the fracture. Results were compared in terms of operative time, hospital stay, union, range of motion and complications. Functional evaluation was done using the Mayos’ elbow performance score (MEPS).: Patients were followed for a minimum of 12 months. Fracture union was seen at or before 4 months in all the patients of both the groups, except in 1 case of Group A where it was seen at 7 months. Average time to union was comparable in both the groups. In Group A, mean range of flexion was found to be 118 degrees (SD 7.33) and extension lag was found to be 11 degrees (SD 3.84). In Group B, mean degree of flexion was found to be 118.25 (SD 4.94) and extension loss of 12 degrees (SD 4.70). Average range of motion was comparable in both groups. There were no significant differences noted between the two groups in terms of mean MEPS (p= 0.573). The overall complication rate was 40% in the TRAP group and 30% in the olecranon osteotomy group.: Intra-articular distal humerus fractures mandate surgical fixation for best functional outcomes. Although technically demanding, TRAP exposure can prove to be as effective as olecranon osteotomy approach. Both approaches appear to yield no significant differences in clinical and functional results for intra-articular distal humerus fracture management.

ROLE OF RING EXTERNAL FIXATOR IN OPEN INTRA-ARTICULAR DISTAL HUMERUS FRACTURE

Standard fixation for intra-articular distal humerus fracture is open reduction and internal fixation (ORIF). However, high energy fractures of the distal humerus are often accompanied with soft tissue injuries and or vascular injuries which limits the use of internal fixation. In our report, we describe a highly complex distal humerus fracture that showed promising healing via a ring external fixator.A 26-year-old man sustained a Gustillo Anderson Grade IIIB intra-articular distal humerus fracture of the non-dominant limb with bone loss at the lateral column. The injury was managed with aggressive wound debridement and cross elbow stabilization via a hinged ring external fixator. Post operative wound managed with foam dressing. Post-operatively, early controlled mobilization of elbow commenced. Fracture union achieved by 9 weeks and frame removed once fracture united. No surgical site infection or non-union observed throughout follow up. At 2 years follow up, flexion - extension of elbow is 20°- 100°, forearm supination 65°, forearm pronation 60° with no significant valgus or varus deformity.The extent of normal anatomic restoration in elbow fracture fixation determines the quality of elbow function with most common complication being elbow stiffness. Ring fixator is a non-invasive external device which provides firm stabilization of fracture while allowing for adequate soft tissue management. It provides continuous axial micro-movements in the frame which promotes callus formation while avoiding translation or angulation between the fragments. In appropriate frame design, they allow for early rehabilitation of joint where normal range of motion can be allowed in controlled manner immediately post-fixation.Functional outcome of elbow fracture from ring external fixation is comparable to ORIF due to better rehabilitation and lower complications. Ring external fixator in our patient achieved acceptable functional outcome and fracture alignment meanwhile the fracture was not complicated with common complications seen in ORIF.In conclusion, ring external fixator is as effective as ORIF in treating complex distal humeral fractures and should be considered for definitive fixation in such fractures.

Plate vs. intramedullary screw fixation of chevron olecranon osteotomies: a biomechanical study

Intra-articular distal humerus fractures frequently require olecranon osteotomies for adequate exposure, but fixation of olecranon osteotomies is associated with high rates of hardware-related complications requiring subsequent reoperation for removal. Intramedullary screw fixation is an attractive option to attempt to minimize hardware prominence. The purpose of this biomechanical study is to directly compare intramedullary screw fixation (IMSF) with plate fixation (PF) of chevron olecranon osteotomies. It was hypothesized that PF would be biomechanically superior to IMSF. Chevron olecranon osteotomies of 12 matched pairs of fresh-frozen human cadaveric elbows were repaired with either precontoured proximal ulna locking plates or cannulated screws with a washer. Displacement and amplitude of displacement at the dorsal and medial aspects of the osteotomies under cyclic loading conditions were measured. Finally, the specimens were loaded to failure. The IMSF group had significantly greater medial displacement (P=.034) and dorsal amplitude (P=.029) than the PF group. Medial displacement was negatively correlated with bone mineral density in the IMSF group (r=-0.66, P=.035) but not in the PF group (r=.160, P=.64). Mean load to failure between groups, however, was not statistically significant (P=.183). While there was no statistically significant difference in the load to failure between the two groups, IMSF repair resulted in significantly greater displacement of the medial osteotomy site during cyclic loading and greater amplitude of displacement dorsally with loading force. Decreased bone mineral density was associated with an increased displacement of the medial repair site. These results suggest that IMSF of olecranon osteotomies may result in increased fracture site displacement when compared to PF; this displacement may be greater in patients with poor bone quality.

Shoulder &amp; Elbow

The April 2023 Shoulder &amp; Elbow Roundup360 looks at: Arthroscopic Bankart repair in athletes: in it for the long run?; Functional outcomes and the Wrightington classification of elbow fracture-dislocations; Hemiarthroplasty or ORIF intra-articular distal humerus fractures in older patients; Return to sport after total shoulder arthroplasty and hemiarthroplasty; Readmissions after shoulder arthroplasty; Arthroscopic Bankart repair in the longer term; Bankart repair with(out) remplissage or the Latarjet procedure? A systematic review and meta-analysis; Regaining motion among patients with shoulder pathology: are all exercises equal?

Ulnar Nerve Neuropathy After Surgery for Intraarticular Distal Humerus Fractures: An Analysis of 116 Patients

To identify the incidence and the factors associated with a postoperative ulnar nerve neuropathy in patients who had undergone open reduction and internal fixation for intraarticular distal humerus fractures. We retrospectively reviewed 116 patients who had undergone surgery between January 2011 and December 2020. Age, sex, BMI, mechanism of injury, open or closed fracture, operation time, tourniquet time, and nerve injury at the final examination were collected from medical charts. We essentially used the paratricipital approach. In cases in which the reduction of intraarticular bone fragments was difficult, olecranon osteotomy was used. Ulnar nerve function was graded according to a modified system of McGowan. We conducted logistic regression analysis to investigate factors of neuropathy using items identified as statistically significant in univariate analysis as explanatory variables. Thirty-four patients (29.3%) had persistent neuropathy at the final follow-up. In the modified McGowan classification, 28 patients had grade 1 and 6 patients had grade 2 neuropathy. Olecranon osteotomy emerged as a distinct explanatory variable for the prophylaxis of ulnar nerve neuropathy in the multivariate analysis (odds ratio, 0.30; 95% confidence interval, 0.12-0.73). Anterior transposition, however, was not a statistically significant factor (odds ratio, 1.91; 95% confidence interval, 0.81-4.56). Olecranon osteotomy was the only independent factor associated with preventing the occurrence of ulnar nerve neuropathy. Ulnar nerve transposition might not be associated with prevention of ulnar nerve neuropathy. Prognostic IV.

Radius of curvature of the radial head matches the capitellum: a magnetic resonance imaging analysis

The purpose of this study is to utilize elbow magnetic resonance imaging (MRI) to compare the radius of curvature (ROC) of the radial head peripheral cartilaginous rim and the cartilage contour of the capitellum to evaluate if the radial head could be a suitable osteochondral autograft for capitellar pathology. All patients who underwent an MRI of the elbow over a three-year period were reviewed. Patients with the following diagnoses were excluded: osteochondritis dissecans, osteomyelitis, tumor, and osteoarthritis. The radius of curvature of the radial head (RhROC) was measured on the axial oblique MRI sequence. The radius of curvature of the capitellum (CapROC) was measured on sagittal oblique MRI sequences, the width of the articular surface of the capitellum on coronal MRI sequences and the radial head height (RhH) and capitellar vertical height on sagittal oblique sequences. All measurements were obtained at the midpoint of the radiocapitellar joint. Spearman's coefficient was used to assess the correlation between ROC measurements. Eighty-three patients were included with a mean age of 43+/- 17 years (57 males and 26 females, 51 right and 32 left elbows). The median RhROC and CapROC measurements were 12.3 mm (interquartile range [IQR] 1.6) and 11.9 mm (IQR 1.7), respectively. The median difference was 0.3 mm (IQR=0.6; CI 95%=[0.24, 0.46]; P<.001). A strong positive correlation was found between RhROC and CapROC (ρ=0.89; r2=0.819; P<.001). Ninety-four percent (78/83) of patients had a median difference between the RhROC and CapROC of less than or equal to 1 mm, and 63% (52/83) were within 0.5 mm. The inter-rater and intra-rater reliability for RhROC and CapROC was good, intraclass correlation coefficient (ICC)=0.89, ICC=0.87, and ICC=0.96, ICC=0.97, respectively. RhH was 10.6±1.3 mm, and the width of the articular surface of the capitellum was found to be 13.8±1.6 mm. The ROC of the convex peripheral cartilaginous rim of the radial head is similar to the ROC of the capitellum. In addition, the RhH was approximately 78% of the capitellar articular width. Based on this imaging analysis, the radial head could prove to be a robust local osteochondral autograft with a similar cartilage contour in the reconstruction of the capitellum in complex intra-articular distal humerus fractures with associated radial head fractures and in the setting of "kissing lesions" of the radiocapitellar joint. Furthermore, an osteochondral plug harvested from the "safe zone" of the peripheral cartilaginous rim of the radial head could be utilized to treat isolated osteochondral lesions of the capitellum.

Percent articular exposure of the distal humerus with triceps fascial tongue approach compared with olecranon osteotomy.

Distal humerus fractures are common and can be difficult to treat. No one approach to the distal humerus has been shown to be superior to another; however, the olecranon osteotomy remains the gold standard for complex, intra-articular fractures. Understanding the percent of articular exposure with approaches to the distal humerus is important for success. The goal of this study is to show the percent of articular exposure of the triceps fascial tongue approach as compared with the olecranon osteotomy. Twelve fresh frozen cadavers were separated randomly into 2 groups of 6 each. The first group of 6 specimens was allocated to the triceps fascial tongue approaches with the collaterals maintained and with the collaterals released off the ulna and elbow dislocated. The second group of 6 was allocated to the triceps fascial tongue approach while maintaining the collaterals followed by an olecranon osteotomy. The articular exposure was marked after performing each approach, and the percent of articular exposure was quantified by using 3D scanning. Standard deviations were calculated for each. The average percent visualization of the distal humerus articular surface in the fascial tongue approach while maintaining the collaterals was 36% in the first cohort and 37% in the second cohort with a standard deviation of 5% in both cohorts. The average percent of the distal humerus articular surface exposed in the fascial tongue approach with the collaterals released off the ulna and elbow dislocated was 85.09% with a standard deviation of 4%. The average percent of the distal humerus articular surface exposed in the olecranon osteotomy group was 57.9% with a standard deviation of 5%. The triceps fascial tongue approach allows for visualization of about one-third of the joint, which may be adequate for many intra-articular distal humerus fractures. For added exposure of the articular surface, the collaterals may be elevated from the ulna and the elbow dislocated allowing for a substantial increase in percent of articular exposure compared with the collateral retaining fascial tongue approach and the olecranon osteotomy.

A PROSPECTIVE STUDY ON INTERNAL FIXATION WITH AN ORTHOGONAL LOCKING PLATE AND OPEN REDUCTION OF AN INTRA-ARTICULAR DISTAL HUMERUS FRACTURE

Background: Surgery for intra-articular distal humeral fractures can be difficult. Total elbow arthroplasty (TEA) versus open reduction and internal fixation (ORIF) for treating elderly patients is still up for debate. In order to compare ORIF with TEA for treating intra-articular distal humerus fractures in patients, this study compared the clinical and functional results. Methods: Between one and half years at Sri Krishna Medical College Hospital, Muzaffarpur, Bihar, India, 70 willing patients with intra-articular distal humeral fractures who underwent osteosynthesis by orthogonal locking compression plating using posterior approach with olecranon osteotomy participated in a prospective study. Results: With a mean age of 38.5 years, our study included 38 male patients and 32 female patients. A motor vehicle collision accounted for 65.2% of instances, an accidental fall accounted for 21.7%, and a fall from height accounted for 13%, with the right side being more frequently afflicted (73.9%). The average operation lasted 100 minutes. Following surgery, the Mayo Elbow Performance Score was 83.3 percent, and the mean arc of mobility was 117°. 82% of cases had excellent to good outcomes. Conclusions: ORIF demonstrated superior results to TEA in patients with intra-articular distal humerus fracture.

Results of intra-articular distal humerus fracture treated with open reduction and internal fixation

Introduction: Distal humerus fractures are uncommon injuries that account for fewer than 2% of all adult fractures. The complex shape of the elbow joint, the adjacent neurovascular structures, and the soft-tissue envelope combine to make these fractures difficult to treat. The treatment usually consists of determining the injury mechanism and developing a treatment algorithm to regain full mobility of the joint. Materials and Methods: This is a prospective study of 20 cases of distal humerus intra-articular fracture treated by open reduction and internal fixation at our institute during 2017–2019. All the patients in this study were above 18 years of age. These patients were treated with open reduction and internal fixation either by paratricipital approach for fractures with minimal intra-articular comminution or by olecranon osteotomy approach for fractures with more intra-articular comminution. Results: In this study of 20 patients with distal humerus fracture treated with open reduction and internal fixation with ages ranging from 18–65 years, 13 (65%) were male patients and 7 (35%) were female patients. 12 (60%) patients had fracture on the left side, and 8 (40%) patients had fracture on the right side. 11 (55%) patients sustained fractures following the fall from height, and 9 (45%) patients had fracture due to a road traffic accident. Postoperatively, 2 (10%) patients had superficial infection; both patients recovered with antibiotics. In our study, 17 (85%) patients had excellent results, and 3 (15%) patients had a good result according to the Mayo Elbow Performance Score. Conclusion: Distal humerus intra-articular fractures require anatomical reduction of intra-articular components. Vigorous, active physiotherapy is a must for good results. Rigid internal fixation is best accomplished by low-profile anatomical plate fixation, which provides an optimal biomechanical stability; hence, early mobilization can be started, and a good functional outcome can be achieved with a low complication rate.