Outcomes Of Distal Humerus Fractures Research Articles

Functional Outcome of Distal Humerus Fractures Treated With Open Reduction and Internal Fixation With Bicolumnar Plating in a Tertiary Care Setting.

Introduction Fractures of the distal humerus in the adult comprise approximately one-third of all humeral fractures. Over the past 20 years, nonoperative treatment for these fractures has been substituted by anatomic reduction and internal fixation based on the Association for Osteosynthesis (AO)/Association for the Study of Internal Fixation (ASIF) philosophy of plate fixation which resulted in early mobilization and superior performance. Pre-contoured, anatomically designed locking plates are anticipated to offer sufficient stability, permit early elbow range of motion, and safeguard the soft tissue.In comparison to any other joint, the elbow's good anatomical alignment, perfect stability, and early mobilization principles are of utmost significance. Methodology A hospital-based consecutive case series of distal humerus fracture patients managed surgically with bicolumnar plating at R.L. Jalappa Hospital Centre, from June 2021 to June 2022 was chosen. Patients were clinically assessed by measuring the range of motion of the elbow with a goniometer. A six-week post-operative review was the first one. Routine checkups were scheduled every four weeks up until there was evidence of fracture consolidation radiologically. Clinically Mayo Elbow Performance score (MEPS) was analyzed at the end of six-month follow-up and tabulated. Institutional Ethical committee permission was taken prior to the study. Results In the study, 47% of cases had an Excellent MEPSfollowed by 33% of patients having a good MEPS and 13% having a Fair MEPS rating. Only 7% of patients had poor MEPS. Among the patients, 33.3% had 90 MEPS followed by 16.6% cases had 85 MEPS. Only 2 patients had55 MEPSin the study. The fracture pattern configuration based on AO classification in our study was C2>C1>C3>A2.3=A3.3. Conclusion Due to an increase in road traffic accidents, complicated distal humeral fractures are becoming more common among younger people. In terms of stability and arc of motion, excellent to good functional outcomes were attained in around 80% of the study group.Because of the extremely stable build system produced by parallel plating, there have been no reported instances of implant failure or non-union.

Functional and radiological outcomes of distal humerus fractures treated with pre-contoured locking compression plate

<p><strong>Background: </strong>Distal humerus intra-articular fractures are one of the complicated fractures managed by orthopaedic surgeons. We did a prospective and a retrospective study on 21 patients with these fractures treated with pre-contoured locking compression plate.</p><p><strong>Methods: </strong>The<strong> </strong>21 patients in this series were followed for a minimum of 1 year. The prospective study cases were followed at 3 months, 6 months and annually. The rating system of the Mayo elbow functional scoring system was used. The radiological evaluation was done using standard AP and lateral views.<strong></strong></p><p><strong>Results: </strong>We had 14 patients with range of motion of 50-100 degrees. There was only one patient with range of motion of <50 degrees. 6 patients had the maximum range motion of >100 degrees. We had 6 (23.57%) excellent, 9 (42.85%) good, 5 (23.80%) fair and 1 (4.7%) poor in the Mayo elbow scoring at the end of 1 year. We were able to compare our outcomes with a study done by Kumar et al done in 2017. They had 27 (89.66%) of excellent and good results as opposed to 27 (79.4%) in our study. Out of 21 patients in our study 17(80.95%) patients had good 11 (52.5%) / excellent 6 (28.5%) results. This was comparable with Jupiter et al. His study of 34 patients 26 (79.40/0) patients showed good 14 (41%) / excellent 13 (38.4%) result.<strong></strong></p><p><strong>Conclusions: </strong>Pre-contoured locking compression plate appears to be technically an ideal implant for comminuted osteoporotic bone providing an angle stable construct.</p>

Functional outcome of distal humerus fracture in adults followed with bicolumnar fixation: A prospective study

Background: Distal humerus Fractures account for about 0.5 - 2% of all adult fractures, out of which a significant percentage (50 - 70%) of patients present with intraarticular and intercondylar involvement; thereby posing operative challenges to the surgeon. An attempt has been made in this study to evaluate the radiological and functional outcome of distal humerus fractures treated with bi columnar fixation. Materials and Methods: Our study consists of 20 posts traumatic distal humerus fracture AO type C operated at Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram between May 2019 and December 2021. The Mayo Elbow Performance Score was employed for the assessment of Functional Outcome. Patients were regularly followed up at the intervals of 6 weeks, 3 months, 6months and 1 year postoperatively. Results: There were 13 (65.0%) female patients, and 7 (35%) male patients over a wide age range of 18 years to 75 years. The mean age of these patients being 44.6 years. The majority had an involvement of the nondominant limb; left humerus 15 (75%) and the rest of the cases were right humerus 5 (25%). The fractures were stabilized with bicolumnar locking compression plates with Lag Screws depending on the fracture pattern. The final follow-up majority showed good to excellent outcomes with the mean arc of elbow flexion of 116 degrees, average extension deficit of 7 degrees, average supination of 70 degrees, and average pronation of 70 degrees. Conclusions: Olecranon Osteotomy approach gave a better visualization of the fracture site and an easier articular reconstruction opportunity. Bicolumnar fixation showed good outcomes and achieved satisfactory union rates.

Effects Supervised Versus Home-Based Rehabilitation on Functional Outcome after Surgical Fixation

Background: The focus for early postoperative motion in stable fixation is aimed at good restoration of joint anatomy in relation to movements, strength, and joint play and to compare the functional outcomes after the surgical repair of distal humerus fractures in contrast with supervised and home-based rehabilitation. Aim: To provide guidelines to effectively manage the post-operative functional complications. Method: Sixty-four patients with the distal humerus fractures were treated surgically, participated in the study at the mean follow up of 6 months. Mayo Elbow Performance Score (MEPS), Disabilities of the Arm shoulder and Hand (DASH), Visual Analogue Scale and Goniometer, radiographic evaluation was done to assess outcomes at baseline (2nd week after cast removal), 10th week &6th month post-operative. Results: Among 60 patients, average MEPS, DASH, Arc of motion was significantly better in supervised rehabilitation group in contrast with home-based rehabilitation group (p=0.00, CI 95%). Average healing time observed on radiographs was 10-12 weeks. The overall complication rate was only 4.7%, while most of the minor complications resolved without any intervention. Conclusions: Outcomes of distal humerus fractures were good to excellent in both groups, whereas supervised rehabilitation provided better outcomes in context with ranger of motion, mobility, and functionality. Keywords: Olecranon Osteotomy, Elbow Fractures, Functional outcome, Elbow Rehabilitation

Functional outcome of distal humerus fractures treated by orthogonal locking compression plating: a short-term study

<div class="OutlineElement Ltr SCXW4322913 BCX0"><p class="abstract"><strong>Background: </strong>In Indian settings, the incidence of distal humeral fractures is associated with motor vehicle accidents and simple accidental falls. The treatment of these fractures continues to remain challenging due to anatomical factors. The present study was carried out to evaluate the functional outcome of distal humerus fractures treated with bicolumn locking compression plates applied orthogonally.</p><p class="abstract"><strong>Methods: </strong>This prospective study was carried out among 15 patients who were diagnosed with fracture of distal humerus. A detailed clinical examination and radiological assessment were done to evaluate the fracture pattern. In complex articular fractures, Chevron V shaped olecranon osteotomy was done. In other cases, routine approaches like TRAP, paratricipital or Triceps splitting approach were used.</p><p class="abstract"><strong>Results: </strong>The most common type of fracture observed was C2 (53.4%) and was associated with fracture of distal radius (26.6%) followed by fracture metacarpals (13.2%). Olecranon osteotomy was the most common surgical approach (40%). Majority of the participants in both the age groups equally showed excellent and good outcomes (42.8% and 37.5% respectively) while males showed excellent outcomes (55.6%) compared to females (16.7%).</p><p class="abstract"><strong>Conclusions: </strong>It is inferred that distal humerus fractures with intraarticular extension can be successfully treated with locking compression plates applied orthogonally. However, a long-term follow-up and a larger sample study is needed to further validate our findings.</p></div>

Functional Outcomes of Distal Humerus Fractures Fixed by Orthogonal Double Plating

Background: Distal humerus fractures constitute 2% of all fractures in the adult population. Surgical intervention is indicated in most cases, and these fractures are often complicated by difficulty in fracture-site exposure, comminution in the metaphyseal or articular region, and the presence of osteoporotic bone. The objective of the study was to assess functional outcome of operative fixation of distal humerus with locking plate and screws Materials And Methods: This is a retrospective study of 30 patients with distal humerus fractures fixed with orthogonal plating from 2018-2019 in KIMS Hospitals, Kondapur, Hyderabad. Functional outcome was assessed using Mayo Elbow Performance score along with other major and minor complications were noted. Results: There were 18 male patients and 12 female patients. Average age of the patients was 39.68 years with age ranging from 18 years to 80 years.16 cases were right humerus and 14 were left humerus involved. All cases we operated through trans olecrenon approach and chevron osteotomy technique, fracture stabilised by orthogonal locking compression plate. 6 fractures were C1, 15 were C2 and 9 were C3 types according to AO classification. Complications were noted in 5 patients. 13.3% patients were rated as excellent, 63.3% were rated good, 16.6% were rated as fair, 6.8% were rated as poor according to Mayo Elbow Performance Scoring. Conclusion: Orthogonal dual plate configurations can provide anatomical reconstruction and stable fixation of Type C intra articular distal humeral fractures and allow early mobilization of the elbow after surgery which result in good functional outcome Keywords: Distal humerus fractures, Trans Olecrenon, Chevron Osteotomy, MEP score.

Functional Outcomes of Distal Humerus Fractures Fixed by Orthogonal Double Plating

Background: Distal humerus fractures constitute 2% of all fractures in the adult population. Surgical intervention is indicated in most cases, and these fractures are often complicated by difficulty in fracture-site exposure, comminution in the metaphyseal or articular region, and the presence of osteoporotic bone. The objective of the study was to assess functional outcome of operative fixation of distal humerus with locking plate and screws Materials And Methods: This is a retrospective study of 30 patients with distal humerus fractures fixed with orthogonal plating from 2018-2019 in KIMS Hospitals, Kondapur, Hyderabad. Functional outcome was assessed using Mayo Elbow Performance score along with other major and minor complications were noted. Results: There were 18 male patients and 12 female patients. Average age of the patients was 39.68 years with age ranging from 18 years to 80 years.16 cases were right humerus and 14 were left humerus involved. All cases we operated through trans olecrenon approach and chevron osteotomy technique, fracture stabilised by orthogonal locking compression plate. 6 fractures were C1, 15 were C2 and 9 were C3 types according to AO classification. Complications were noted in 5 patients. 13.3% patients were rated as excellent, 63.3% were rated good, 16.6% were rated as fair, 6.8% were rated as poor according to Mayo Elbow Performance Scoring. Conclusion: Orthogonal dual plate configurations can provide anatomical reconstruction and stable fixation of Type C intra articular distal humeral fractures and allow early mobilization of the elbow after surgery which result in good functional outcome Keywords: Distal humerus fractures, Trans Olecrenon, Chevron Osteotomy, MEP score.

To study the clinical outcome in distal humerus fractures with orthogonal plating via the olecranon osteotomy approach

Objective: The aim of our study was to evaluate the clinical outcome of distal humerus fractures treated with orthogonal plating via the olecranon osteotomy approach in the Indian population, at a tertiary care centre in Kolhapur. Method: A prospective study was carried out in a tertiary care center in Kolhapur. A total number of 16 patients with fractures of distal humerus (AO type B and C) were studied between May2019 to August 2020. All were treated with orthogonal plating via the olecranon osteotomy approach. A mean follow up of 6 months was carried out, and evaluation was done with the help of MEPS and DASH scoring system. Result: The mean radiological union time was 14.6 weeks with an arc of flexion of 101.2 degrees. The outcome measured using Mayo Elbow Performance Score (MEPS) and DASH scoring was 89 and 15.4 points respectively at 6 months. Patient satisfaction was 87% at the end of 6 month follow-up.25% patients reported complications like infection (1 patient), delayed wound healing (2 patients) and hardware prominence (1 patient). No cases of infection or peripheral neuropathies were reported in any of the patients. Conclusion: Orthogonal plating via the olecranon osteotomy approach remains a good alternative showing good clinical outcome in the treatment of distal humerus fractures (AO type B and C). It offers a more stable fixation and the olecranon osteotomy approach gives better exposure for surgery.

Functional outcome of distal humerus fractures treated with an extensor mechanism sparing Paratricipital approach

Functional outcome of distal humerus fractures treated with an extensor mechanism sparing Paratricipital approach

Outcomes of distal humerus fractures: What are we measuring?

IntroductionWe evaluate the most common outcome measures used in distal humerus fracture studies in order to suggest standardization for future research. Materials and methodsA systematic review identified articles assessing the outcomes of acute distal humerus fractures from 2006 to 2016 from PubMed and Web of Science databases. The inclusion criterion was studies reporting on the outcomes of treatment of acute distal humerus fractures. Review articles, meta-analyses, studies with<5 patients, technique articles, biomechanical studies, and those focusing on one complication/outcome were excluded. Patient demographics and all outcome measures were reviewed. Journal and demographic factors were then compared. ResultsOne-hundred-nine of 2158 articles met inclusion criteria. The median number of fractures per study was 35. Mean patient age was 55.0 years. Average follow-up was 35 months. Range-of-motion and strength measurements were reported in 90% and 17% of studies, respectively. Twenty patient-reported outcome instruments were used. The most commonly reported measures were MEPS, DASH, VAS pain, and Quick DASH scores. An average of 1.9 outcome measures were reported per study. A journal impact factor of≥1.5 was associated with more reported outcome measures. Articles including elbow arthroplasty were associated with higher impact factor journals, more outcome measures, and longer follow-up. Level of evidence was not associated with the number of reported outcome measures. DiscussionThe current distal humerus fracture literature inconsistently reports outcome measures. More outcome measures were reported in higher impact journals. Future distal humerus fracture studies should include MEPS, DASH or Quick DASH, and VAS Pain scores to allow for appropriate cross-study comparison. Level of evidenceIV, Systematic review.

A study of functional outcome of distal humerus fractures managed by locking compression plate

Introduction: Fractures of the distal humerus are rare and complex injuries. The complex shape of the elbow joint, the adjacent neurovascular structures, the sparse soft tissue cover combine to make treatment difficult. Distal humerus locking plates provides greater stability by permitting multiple screws in distal fragment there by overcoming some of the limitations of conventional plates. Methodology: 20 patients of distal humerus fractures treated by distal humerus plates with a mean follow up of 6 months from January 2015 to June 2016 in adichunchanagiri institute of medical sciences and research centre and results were assessed using mayo elbow performance score Results: The sample consisted of twenty patients with 15 males and 05 were female. The patients’ ages ranged from 21-70 years with a mean age of 40.25 years. The causes of fractures were motor vehicle accident in 13 patients and fall in 07 patients. There were no sports or industrial accidents. 12 fractures involved the left side and 08 involved the right. The average number of days from injury to surgery was 3.2 days with a range of 1 to 06 days. The operative time ranged from 60 minutes to 150 minutes. Patients were followed up for 6 months. 2 patients had elbow stiffness, 1 case each of ulnar neuropathy, and superficial infection. Conclusion: We conclude that anatomically pre-shaped distal humerus locking plate system gives promising results in terms of functional outcome, range of movement and stability of the elbow by providing stable fixation for complex distal articular fracture and facilitating early postoperative rehabilitation.

The challenging surgical treatment of closed distal humerus fractures in elderly and octogenarian patients: radiographic and functional outcomes with a minimum follow-up of 24months.

The main purpose of this retrospective, non-randomized, case series study was to evaluate the clinical and radiographic outcomes of distal humerus fractures (DHFs) in a consecutive series of elderly patients operatively treated by two surgeons, and second, to identify proper indications for two elderly age ranges and two fracture pattern groups. From January 2009 to June 2014, 51 patients (pts) underwent open reduction and internal fixation (ORIF) using the locking compression plate (LCP) distal humerus plate (DHP) system at our institution. Medical records and radiographs were retrospectively assessed. Patients were divided into 3 groups according to gender, age (pts <85years, pts ≥85years) and AO classification (13-B1-B2-C1-C2 or 13-C3). All subjects completed MEPS, Quick-DASH and SF-36 PCS/MCS scores at final follow-up, and statistical analysis was performed. 36 patients (20 women, 16 men), mean age 80.3years, with AO type 13-B and 13-C DHFs were included with a mean follow-up of 56months (range 24-92). The most common mechanism of trauma was a fall from ground level (55.6%). The mean MEPS was 78.9 points, Quick-DASH 28.4, SF-36 PCS 48.3 and MCS 48.9. There was statistically significant evidence that having a 13-C3 fracture leads to worse results in MEPS, Quick-DASH and SF-36. The female gender correlates with worse results in SF-36. The patients ≥85years had a worse prognosis according to Quick-DASH and SF-36, while the AO 13-C3 pattern obtained the worst ROM outcomes versus AO 13 B1-B2-C1-C2 (normal ROM 0°-140°): mean ROM 24°-114° vs 10°-130°, mean flexion deficit 26° vs 10°, mean extension deficit 24° vs 10°, respectively). Complications were presents in 36.1% of patients, overall belonging to the AO type 13-C fracture pattern and to the group ≥85years. These study data seem to confirm our hypothesis that plate fixation for DHFs guarantees adequate fracture osteosynthesis and satisfactory functional outcomes at medium to long-term follow-up, not only in elderly patients, but also in octogenarian osteoporotic patients (≥85 years) with 13-C1 and 13-C2 fracture patterns, while an alternative solution should be considered for type C3 fractures, even in a primary trauma setting.

A study of functional outcomes of distal humerus fractures operated by triceps reflecting approach

Introduction: Approaches to distal humerus has been a great controversy of which cheverons osteotomy is considered a gold standard. However it is associated with implant and procedure related complication, Hence we studied a triceps reflecting (Bryan –Morrey) approach with some modification so as to achieve good exposure to distal humerus with intact olecranon. Methods: In our study we retrospectively studied 13 skeletally mature distal humerus fractures at our center treated by TRA with minimum follow up for a period of 3 months. They were functionally assessed with DASH Score, MAYO score, triceps power evaluation with MRC grading, measurements of ROM and Radiological union. Results: Mean duration of follow up was Ten months in 13 patients, with an average age of 43.23 years. The mean Quick DASH score was 3.85, mean Mayo score was 89 indicating an good performance, mean Triceps muscle power MRC grading 5 with adequate mean functional ROM 23-114 degree(extension –flexion). Only 2 patients had complication of which one was screw breakage and other was wound dehiscence which was not related to approach. Conclusion: TRA is a better option as it avoids creating a new fracture and preserving the joint anatomy as compared to olecranon osteotomy with adequate exposure of the joint to carry out the fixation. As from our series functional outcomes of strength of triceps is comparable with that of the other side.

Outcomes of distal humerus fractures in patients above 65 years of age treated by plate fixation

Distal humerus fractures in elderly patients are often complex fractures that are difficult to treat. The goal of this study was to report on the results of a multicentre series of internal fixation of AO type A, B and C distal humerus fractures in elderly patients and to identify the pros and cons of various fixation constructs. Two studies were performed. One was a prospective multicentre study with 53 patients and the other was a retrospective multicentre study with 289 patients, all above 65 years of age and with a recent distal humerus fracture. Patients were evaluated based on clinical criteria (history, health condition, joint range of motion, Mayo Elbow Performance Score) and radiological criteria (fracture type, union of fracture, presence of malunion, hardware condition). Based on the MEPS, the clinical and functional results were relatively satisfactory: average of 92 points for type A, 82 points for type B and 88 points for type C. In both series, type B fractures were the most difficult to treat and had less good clinical, functional and radiological outcomes. Most of the complications occurred with type C fractures; these consisted mainly of nerve injuries and fixation failure/non-union. Although these fractures are difficult to treat and have an appreciable number of complications, the functional recovery was fairly satisfactory. One of the most challenging aspects of surgical treatment is the existence of osteoporosis in these patients. This must be carefully analysed to determine if an indication exists for total elbow arthroplasty. IV.

Elbow Fractures: Distal Humerus

A distal humerus fracture can be a debilitating and difficult injury to treat. The anatomy of the distal humerus is highly complex, as it articulates with both the radius and ulna and allows for motion in multiple planes. Furthermore, comminution and osteopenia may render the metaphyseal-diaphyseal junction weak, making adequate stabilization difficult. Various methods of surgical fixation have been described, with bicolumnar plating being the most popular. Controversy over fixation techniques and the introduction of recently developed implants, including precontoured plates and locking plates, have led to renewed focus on biomechanical testing of various fixation constructs. Failure of adequate reconstruction or fixation can be addressed with adjunctive measures such as incorporation of structural bone grafts, external fixation, or, in certain instances, salvage with total elbow arthroplasty. The articular surface can also be injured from a shear force, resulting in fractures of the capitellum and trochlea in the coronal plane. This article presents a review of current literature concerning the diagnosis, classification, treatment, and outcome of distal humerus fractures.