Treatment Of Intercondylar Fractures Research Articles

Comparison of clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by either parallel or orthogonal double plating

Objective To compare the clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by open reduction and internal fixation (ORIF) with either parallel or orthogonal double-plate. Methods From January 2013 to December 2017, 54 patients with humeral intercondylar fracture were treated at Department of Orthopedic Trauma, Jishuitan Hospital by ORIF with anatomical locking compression plate (LCP) (either parallel or orthogonal double-plate configuration). According to their age, the patients were divided into a young group (from 18 to 30 years old) of 29 cases with an age of 25.5±3.6 years and an elderly group (≥60 years old) of 25 cases with an age of 67.1±5.8 years. The 2 groups were compared in terms of perioperative data, ranges of motion (flextion, extension and rotation), numeric rating scale for pain (NRS), Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) at the last follow-up, complications and secondary surgery. Results The 2 groups were comparable because there were no significant differences in the preoperative general data except in injury energy, combined injury and gender between them (P>0.05). The young group had significantly more cases of high-energy injury and combined injuries than the elderly group(P 0.05), but the elderly group had significantly higher Quick-DASH scores (13.9±14.4 points) than the young group (5.7±8.9 points) (P 0.05), but the rate of secondary surgery in the young group (37.9%, 11/29) was significantly higher than that in the elderly group (4.0%, 1/25) (P<0.05). Conclusions In the treatment of humeral intercondylar fractures, ORIF with LCP (either parallel or orthogonal double-plate configuration) can lead to similarly safe and effective clinical outcomes for both young and elderly patients. Key words: Humeral fractures; Young people; Elderly; Fracture fixation, internal; Bone plates

Efficacy comparison between plate fixation with in situ reinforcing ulnar nerve and anterior transposition for humeral intercondylar fracture

Objective To investigate the clinical efficacy of plate fixation with in situ reinforcing ulnar nerve and anterior transposition by olecranon osteotomy approach in the treatment of type C2 and C3 humeral intercondylar fractures. Methods A retrospective case control study was conducted to analyze the clinical data of 23 patients with humeral intercondylar fractures admitted to the Affiliated Hospital of Hangzhou Normal University from June 2014 to January 2017. There were 17 males and six females, aged 19-56 years, with an average of 41.2 years. According to AO classification, there were 15 patients with type C2 and eight with type C3. All patients were treated with plate internal fixation by olecranon osteotomy approach. The patients were divided into anterior group (11 patients) which was treated with ulnar nerve release anterior transposition and in situ reinforcing group (12 patients) which was treated with ulnar nerve release in situ. The operation time, intraoperative blood loss, fracture healing time, elbow flexion and extension range, elbow joint Mayo score, and excellent and good rate were compared between the two groups. Postoperative complications were recorded. Results All patients were followed up for 15-43 months, with an average of 26.7 months. All patients had no need of blood transfusion. There were no significant differences between anterior group and in situ reinforcing group in operation time [(219.1±15.1)minutes vs. (211.2±17.1)minutes], intraoperative blood loss [(263.6±35.3)ml vs. (237.5±25.6)ml] and fracture healing time [(18.2±2.4)weeks vs. (18.9±1.7)weeks] (P>0.05). No significant differences were found between the two groups in elbow flexion [(120.3±7.1)° vs. (120.3±4.1)°], straightness [(3.7±2.7)° vs. (4.1±2.4)°], Mayo score [(89.09±9.17)points vs. (86.67±10.29)points] and excellent and good rate [ 91% (10/12) vs. 83% (10/12)] (P>0.05). After operation, no complications such as infection, heterotopic ossification, ulnar neuritis, elbow valgus deformity, or internal fixation failure occurred. Conclusions For humeral intercondylar fracture, the plate fixation with in situ reinforcing ulnar nerve and anterior transposition by olecranon osteotomy approach both have advantages such as small surgical trauma, strong fixation, fewer complications, satisfactory recovery of elbow function. Ulnar nerve anterior transposition or not does not affect the occurrence of ulnar neuritis, and both can obtain satisfactory clinical efficacy. Key words: Humeral fractures; Intra-articular fractures; Fracture fixation, internal; Ulnar nerve

Comparison of the effects of different fixation methods in the treatment of intercondylar comminuted fracture of the femur

Objective To compare the effects of different fixation methods in the treatment of femoral intercondylar comminuted fracture. Methods From May 2015 to May 2017, 88 cases with femoral intercondylar comminuted fracture in Jiaxing Hospital of Zhejiang Armed Police Corps were selected in the research.According to the different fixation methods, the patients were divided into two groups.The control group(n=46) received dynamic condylar screw internal fixation treatment, the observation group(n=42) received the combination of fixed bridge treatment system.The related indicators of perioperative period, recovery of function after surgery, incidence of complications were compared between the two groups. Results The operation time, amount of bleeding, postoperative drainage, fracture healing time, postoperative weight-bearing time of the observation group were (104.36±20.72)min, (180.62±12.65)mL, (93.47±9.16)mL, (9.42±0.51)weeks, (4.62±1.81)weeks, respectively, which of the control group were (120.36±17.18)min, (269.74±20.24)mL, (62.31±7.34)mL, (10.32±0.67) weeks, (10.33±1.75)weeks, respectively, there were statistically significant differences between the two groups(t=3.96, 24.49, 17.50, 7.04, 15.04, all P<0.05). The joint function recovery rate of the observation group was 95.24%, which was higher than 76.09% of the control group(χ2=6.40, P<0.05). The incidence rate of complications in the observation group(4.76%) was lower than that in the control group(21.74%)(χ2=5.37, P<0.05). Conclusion The effect of bridged composite fixation system in the treatment of femoral intercondylar comminuted fracture is more effective than dynamic intercondylar screw fixation, and the clinical application value is higher than dynamic intercondylar screw fixation. Key words: Femoral fractures; Fracture fixation; Controlled clinical trial

Modified anconeus flap approach for intercondylar humerus fractures

Objective To report a new surgical approach(modified anconeus flap approach)in which the anconeus and part of triceps are reflected in the treatment of distal intercondylar humerus fracture(AO type C). Methods To design the modified anconeus flap approach, the anatomy of the distal tendon of the triceps brachii and the anconeus was studied using 15 cadaveric adult specimens(30 sides). The new surgical approach was compared with the triceps-reflecting anconeus pedicle(TRAP)approach in terms of the area of exposure at the distal humeral articular surface. Furthermore, the new surgical approach was applied in 16 patients who had been treated for intercondylar humerus fracture(AO type C)from May 2005 to May 2013. The clinical outcomes were evaluated using the Mayo elbow performance score(MEPS)and Broberg-Morrey scoring systems. Results The blood supply and innervation of the anconeus was interrupted minimally during incision along the radical edge of triceps tendon. The area of exposure at the distal humeral articular surface provided by the part triceps and anconeus reflecting approach and the medial humerus approach was 42. 66% ±0. 03% at the elbow flexion from 0° to 50°. This was significantly smaller than that provided by the TRAP approach(46. 11% ± 0. 03%)(P< 0. 05). Of the 16 patients, 15 obtained complete follow-ups from 6 months to 4 years(average, 16. 5 months). The mean MEPS at the last follow-up was 90. 5 points(range, from 82 to 93 points), with 10 excellent and 4 good cases and one poor case. The Broberg & Morrey score system showed 11 patients with no articular cartilage degeneration(level-0), 3 patients with level-1 degeneration, and 2 patients with level-2 degeneration. Conclusion The modified anconeus flap approach proposed in the present study provides clear surgical vision and needs no olecranon osteotomy or olecranon dissection or ablation of the major triceps brachii tendon for intercondylar humerus fractures, thereby leading to early active motion and satisfactory clinical outcomes. Key words: Humeral fractures; Autopsy; Therapies, investigational; Surgical approach

A Meta-analysis of perpendicular plating versus parallel plating in treatment of intercondylar humeral fractures

Objective To systematically compare the efficacy of perpendicular plating versus parallel plating in the treatment of intercondylar humeral fractures. Methods Such databases as PubMed, EMbase, Cochrane Library, Chinese Biomedical Literature Database, WANFANG database and China National Knowledge Infrastructure were searched from their establishment to September 2014 for the randomized controlled trials (RCTs) investigating perpendicular plating versus parallel plating in the treatment of intercondylar humeral fractures. The references of the RCTs included were also searched by hand. The retrieved RCTs were screened by inclusion and exclusion criteria before data extraction and quality assessment. The meta-analyses were performed using the software RevMan5.1. The level of evidence was assessed by the GRADE system. Results Eight RCTs involving 389 patients were included. The meta-analyses showed no statistically significant differences between perpendicular plating and parallel plating in operation time, fracture healing time, postoperative complications, elbow flexion and extension, forearm rotation, postoperative Mayo Elbow Performance Score or Cassebaum score (P > 0.05). According to the GRADE system, all the evidence was at intermediate level and for moderate recommendation. Conclusions Both perpendicular plating and parallel plating can lead to similarly effective treatment of intercondylar humeral fractures. Both of them can achieve stable fixation. Key words: Humeral fractures; Elbow joint; Fracture fixation, internal; Meta-analysis

Double plate for treatment of humeral intercondylar fractures

Objective To evaluate the effects of double plates in the treatment of humeral intercondylar fractures. Methods From January 2004 to March 2011,31 patients with humeral intercondylarfractures were reviewed.According to AO/Muller classification,there were three patients with type C1 fractures,16 with type C2 and 12 with type C3.Trans-olecranon osteotomy or trans-triceps-side approach and internal fixation by standard method of AO double plates were performed in all patients. Results All 31patients were followed up for 12 -18 months,which showed fracture healing 6-12 months after surgery.According to the Cassebaum scoring system,the effects were evaluated as excellent in seven patients,good in 19,fair in four and poor in one,with excellence rate of 87％. Conclusion Double plates is proved to be a good choice for humeral intercondylar fractures,since it can obtain satisfactory outcome with solid fixation,stable mechanical properties,few complications and facilitation for early rehabilitation. Key words: Humerus ; Fracture fixation, internal ; Double plates

Treatment of humeral intercondylar fractures with bilateral orthogonal precontoured anatomical plates

Objective To introduce a new type of bilateral anatomical plates used for treatment of intercondylar fractures of humerus. Methods From March 2007 to September 2009, we treated 35 patients with intercondylar fracture of humerus with distal anatomical humeral plates(Zimmer) and distal anatomical humeral locking plates (Synthes). By AO classification, there were 19 elbows of C1, 11 elbows of C2 and 5 elbows of C3. The surgical approach was either bilateral or via olecranon process of ulna. Early mobilization was initiated after surgery. Results All the patients were followed up with a mean follow-up period of 14 months. No non-union was discovered. According to Mayo elbow performance score (MEPS), 20cases were excellent, 10 were good, 4 were fair and one was poor. Conclusion Treatment of an intercondylar humeral fracture with bilateral anatomical plates can gain immediate stabilization which facilitates early mobilization of the elbow. Key words: Humeral fracture; Elbow joint; Fracture fixation, internal

Clinical study of treatment of intercondylar fractures of the distal humerus by double plate fixation viacombined medial and lateral triceps approach

Objective To evaluate the treatmene results of double plating of type C1,C2(AO/ASIF) intercondylar fractures of the distal humerus through combinod mediolateral tricepe-sparing approach (TSA).Methods A retrospective analysis of 7 cases of intercondylar comminuted fractures of the distal humerus was conducted. There were 3 cases of type C1 and 4 cases of type C2. All the patients were treated with open reduction and double plate and cannulated screw fixation through combined mediolateral triceps-sparing approach. Results Postoperative follow up period was 15 montks (range, 8 to 18 months). Results were evaluated using the Mayo Elbow Performance Score (MEPS). Five cases were graded as excellent, while 2 cases good. Average elbow flexion was (118.6±11.4)°. Average extension lag was (22.9±12.1)°. Carrying angle was (20±5)°. No implant loosening or breakage was noted. Conclusion Combined mediolateral TSA is an ideal approach for fixation of type C1, C2 intercondylar fractures of the distal humerus in that it provides adequate exposure to the fracture site, facilitates fracture reduction and allows early rehabilitation. Key words: Humeral fractures; Fracture fixation, internal; Orthopedic procedures

Treatment of type C intercondylar fractures of distal humerus using dual plating

To evaluate the clinical outcome of dual plating in the treatment of humeral intercondylar type-C fractures in adults. From June 2004 to October 2007, 38 cases of type-C distal humeral fractures were stabilised with dual plating. There were 21 males and 17 females. The average age was 43 years with a range from 21 to 71 years. According to the AO classification, 9 cases were of type C1, 17 of C2 and 12 of C3. The posterior midline approach was selected. Twenty-one cases were exposed through the trans-olecranon osteotomy, 11 through the Campbell (Van Gorder) approach, 6 through triceps sparing approach. Autogenous bone graft was performed in 5 cases because of severe comminution. Thirty-five patients were followed-up for 14-30 months (mean 24.2 months). At the latest follow-up, the elbow flexion averaged 119 degrees (range 90 degrees - 135 degrees ), and the loss of extension averaged 16.2 degrees (range 5 degrees - 25 degrees ). All the patients got bony healing, the average healing period was 14 weeks. The patients were evaluated using the criteria of Aitken and Rorabeek and the scores were 13 excellent, 16 good, 6 fair. Twenty-nine patients (82.9%) had a good or excellent results. Complications included 4 cases of traumatic osteoarthritis, 2 heterotopic ossification, 1 ulnar neuropathy. Infection as well as loosening or breakage of the implant was not found. The dual plating is able to provide rigid fixation for the humeral intercondylar fractures. In addition, it can allow early functional exercise after operation, decrease the related complications significantly, and improve the functional results.

Surgical Treatment of Intercondylar Fracture of the distal Humerus through the Modified Triceps Sparing Approach

Purpose: We evaluated the therapeutic results of intercondylar fractures of the distal humerus that were treated through the modified triceps sparing approach. Materials and Methods: From February, 1997 to september, 2001, we reviewed sixteen cases of intercondylar fracture of the distal humerus, which were treated by surgical treatment. The follow up period ranged from one year to three years, averaging 1 year 8 months. The articular surface of the distal humerus was exposed through elevation of the triceps from the medial and the lateral intermuscular septum. The ulna nerve was identified and protected, and then, the fracture sites were fixed with double plates. The functional results were evaluated using Broberg and Morrey's functional scale. Results: All united at 14.5 weeks in an average. The functional results were as follows; three excellent, ten good, two fair and one poor. The range of the elbow joint motion was flexion contracture 11 degree to further flexion 130 degree in average. The one patient presented poor result had coronal shear fracture of the capitulum combined with severe comminution. The incomplete ulnar nerve palsy developed in one case. Conclusion: The modified triceps sparing approach provided sufficient exposure for rigid fixation of intercondylar fracture of the humerus. But in cases with severe comminution or coronal shear fracture, additional anterior approach or olecranon osteotomy should be considered.

Intercondylar T Fractures of the Humerus in the Adult

The treatment of intercondylar fractures in adults should be determined on the basis of the amount of rotatory deformity and comminution. Severely comminuted fractures do not lend themselves to open reduction and are best treated with skeletal traction and gentle closed manipulation when necessary. In the minimally displaced fractures, good results can be obtained by immobilization in a plaster cast. The findings in this small series suggest that fractures with significant rotatory deformity but without gross comminution are more likely to have a good result when skeletal traction is used rather than open reduction and internal fixation. Open reduction and adequate internal fixation are not easy and would seem to offer little chance of a good outcome. We feel that open reduction is very rarely indicated.