Treatment Of Distal Humeral Fractures Research Articles

The treatment of distal humeral fractures in the elderly

The treatment of distal humeral fractures in the elderly

Approaches to distal humeral fractures in adults and comparison of treatment results

We compared the results of surgical techniques used in the treatment of distal humeral fractures. The study included 22 patients (15 men, 7 women; mean age 52 years; range 21 to 80 years) who were treated for closed distal humeral fractures. The fractures were classified according to the Müller's classification (18 type 3, 4 type 4) and Mehne-Matta's classification of intraarticular fractures. Following open reduction, internal fixation was performed with the use of double reconstructive plates in seven patients (32%), multiple K-wires in eight patients (36%), and multiple screws in seven patients (32%). The mean follow-up period was 42 months (range 24 to 72 months). The results were assessed using the Mayo Elbow Performance Scoring system. The results were very good in five patients (22.7%), good in eight patients (36.4%), fair in five patients, and poor in four patients (18.2%). Valgus and varus deformities were found in six (27.3%) and three (13.6%) patients, respectively, and 12 patients (54.6%) had decreased muscle strength. Two patients (9.1%) in the K-wire group developed instability due to insufficient union. Heterotopic ossification was detected in five patients (22.7%). None of the patients had persistent or severe pain. Two patients (9.1%) were free of pain, while 11 patients (50%) had occasional and mild pain, and nine patients (40.9%) had moderate pain on activity. The mean Mayo Elbow Performance scores were 88, 72, and 55 with plate, screw, and K-wire applications, respectively. It was concluded that open reduction followed by internal fixation with double reconstructive plates was superior to K-wire and screw fixations in the treatment of distal humeral fractures.

上腕骨遠位端骨折に対するＯＮＩ ｔｒａｎｓｃｏｎｄｙｌａｒ ｐｌａｔｅの使用経験

We report a study comparing the use of the screw with ONI transcondylar plate in the treatment of distal humeral fracture at our hospital. Use of the ONI transcondylar plate tends to be better than the screw on fixation. Use of the ONI transcondylar plate is considered to be a useful fixation material for distal humeral fracture.

Treatment of distal humeral fractures in the elderly patients

Treatment of distal humeral fractures in the elderly patients

Treatment Options for Fixation Failure in Distal Humeral Fractures

Summary The treatment of distal humeral fractures has evolved over the past several decades. Due to advances in surgical techniques, as well as internal fixation devices, open reduction and internal fixation for an adult distal humeral fracture is now the rule rather than the exception. As the number of operative cases increases, so does the number of postoperative complications. One complication that can occur is failure of the implanted device intended to provide stability to the fracture. Multiple causes including osteopenia, infection, comminution, and poor initial fixation have all been identified. Loss of fixation at the fracture site often leads ultimately to nonunion. The treatment of fixation failure in the elbow can be especially difficult as soft tissue problems frequently contribute to the dilemma. In an effort to achieve a stable, pain-free range of motion in the elbow, several different options exist for the practicing orthopedist who chooses to treat these challenging situations. Revision osteosynthesis with bone grafting, semiconstrained total elbow arthroplasty, arthrodesis, allograft reconstruction, and the “bag-of-bones” technique have all been described as ways to obtain a satisfactory outcome for both the patient and the treating orthopedist.

The treatment of distal humeral fractures in the elderly

The treatment of distal humeral fractures in the elderly

Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients

Distal humeral fractures are difficult to treat. In the elderly population, the problems are compounded by osteoporosis and gross comminution. Open reduction and internal fixation for such fractures is sometimes difficult and may be associated with poor results. Total elbow arthroplasty has been suggested as a last-ditch effort to salvage functional use for such difficult fractures in the elderly. We followed seven patients (seven elbows) with a mean age of 81.7 years at the time of injury. Open reduction and internal fixation was considered a difficult option for these fractures. They were treated with a total elbow arthroplasty using the semi-constrained Coonrad–Morrey elbow replacement prosthesis. The duration of follow up at present is between 2 and 4 years. At the latest follow up the mean arc of flexion is 20–130°. Six patients have no pain while one complains of mild pain. All elbows are stable. The Mayo elbow performance score for five elbows is excellent and two scored good. All but one patient are satisfied with the result. One patient developed superficial wound infection which resolved after antibiotic therapy. One patient has developed post-operative triceps weakness. There have been no cases of deep infection, ulnar nerve neuritis or component failure. The rarity of this procedure suggests its very narrow spectrum of indication. We feel that the short-term results do suggest an important role for semi-constrained total elbow arthroplasty in managing carefully selected comminuted distal humeral fractures in the elderly, especially those that cannot be treated by conventional open reduction and internal fixation.

THE TRICEPS-REFLECTING ANCONEUS PEDICLE (TRAP) APPROACH FOR DISTAL HUMERAL FRACTURES AND NONUNIONS

Adequate exposure is a prerequisite for treatment of distal humeral fractures, as with most surgical procedures. Challenging as they may be to reduce and fix, these fractures can be made more or less difficult to treat based on exposure; complications of successful treatment may arise as a result of the exposure. In this article the authors describe the triceps-reflecting anconeus pedicle (TRAP) approach to the distal humerus, which provides an extensile and versatile approach for treatment of fractures and nonunions. The TRAP approach provides almost the same exposure as an olecranon osteotomy, without the complications of the osteotomy, and has the added advantage of retaining the whole olecranon to use as a template against which to assemble the articular fragments of the trochlea.

The Operative Treatment of Distal Humeral Fractures in the Elderly

The Operative Treatment of Distal Humeral Fractures in the Elderly

Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients.

We retrospectively reviewed the results of primary total elbow arthroplasty for the treatment of an acute fracture of the distal aspect of the humerus in twenty consecutive patients (twenty-one elbows) who had a mean age of seventy-two years (range, forty-eight to ninety-two years) at the time of the injury. The patients were managed between November 1982 and October 1992. The presence of rheumatoid arthritis in nine patients (ten elbows) influenced the choice of treatment. The mean interval between the injury and the total elbow arthroplasty was seven days (range, one to twenty-five days). The mean duration of postoperative hospitalization was seven days (range, four to thirteen days). The mean duration of follow-up was 3.3 years (range, three months to 10.5 years). All patients were followed for a minimum of two years or until the time of death; the duration of follow-up was less than two years for three patients who died. None of the patients were lost to follow-up. Twenty implants were intact at the latest follow-up examination. One patient had a revision total elbow arthroplasty twenty months after the index procedure because of a fracture of the ulnar component sustained in a fall on the outstretched arm. On the basis of the Mayo elbow performance score, fifteen elbows had an excellent result and five had a good result; there were inadequate data for one elbow. There were no fair or poor results. The mean arc of flexion was 25 to 130 degrees. There was no evidence of loosening on the radiographs. Postoperative complications included fracture of the ulnar component in one patient, ulnar neurapraxia in three, and reflex sympathetic dystrophy in one. The results suggest that total elbow arthroplasty can be an alternative form of treatment of a severely comminuted fracture of the distal aspect of the humerus in older patients even in the presence of rheumatoid arthritis. This procedure is not an alternative to osteosynthesis in younger patients.

Operative treatment of distal humeral fractures in the elderly

We treated 49 patients at an average age of 80 years (75 to 90) with distal mostly intraarticular humeral fractures by open reduction. There were 8 class A, 13 class B and 28 class C fractures on Müller's classification. The patients were reviewed at a postoperative average of 18 months. The patients' assessment of the result was very good in 31%, good in 49%, fair in 15% and poor in 5%. The flexion-extension range was very good in 41%, good in 44% and fair in 15%. The incidence of implant failure, pseudarthrosis of the olecranon osteotomy and ulnar nerve lesion was no higher in these elderly patients than in younger patients. Old age is not a contraindication to open reduction and internal fixation; it is important to restore full function.

成人上腕骨下端骨折の治療経験

成人上腕骨下端骨折の治療経験