Bilateral plate fixation for type C distal humerus fractures: experience at a single institution

Abstract

Type C fractures of the distal humerus are difficult to treat and typically require open anatomical reduction and internal fixation. Here we describe our experience treating patients with type C distal humerus fractures using a trans-olecranon approach with bilateral plate fixation. Fifty-six patients (30 males, 26 females; mean age 49.8 years) were treated over a period of six years. Thirteen fractures were open and 43 closed; all were caused by falls or traffic accidents. All operations were performed successfully with no intraoperative complications. Mean duration of follow-up was 30 months (range 6-70). Mean duration of fracture healing was 2.8 months (range 2-4). Forty-seven out of 56 patients (84%) suffered no postoperative complications. One patient exhibited symptoms of ulnar nerve injury following surgery (nine exhibited symptoms before and after surgery). Two patients had mild cubitus varus deformities, four delayed olecranon osteotomy site healing, and two heterotopic ossifications. In summary, complications were minimal and outcomes satisfactory in patients with type C distal humerus fractures who underwent bilateral plate fixation via a trans-olecranon approach.

The comparison of triceps-reflecting anconeus pedicle and olecranon osteotomy approaches in the treatment of intercondylar fractures of the humerus

“…[13] On the other hand, delayed union, nonunion, necessity of implant use to repair osteotomy, and prominent hardware that leads to a second surgery are among the disadvantages. [7][8][9]14,15,23,24] Furthermore, nerve supplies of the anconeus muscle might be damaged, as this muscle participates in the dynamic stabilization of the elbow joint, this may cause elbow instability. [23] Wilkinson et al [13] have compared the triceps split, TRAP, and olecranon osteotomy techniques in a cadaveric study.…”

“…[13,14] However, olecranon osteotomy has disadvantages such as delayed union, nonunion, avascular necrosis, heterotrophic ossification, and prominent hardware. [7][8][9]14,15] TRAP approach, as defined by O'Driscoll et al, [12] is an alternative approach in these fracture patterns. This approach is a combination of modified Kocher and Bryan-Morrey, mobilizes the triceps and anconeus muscle of the posterior humerus, and also provides adequate exposure of distal humerus.…”

Pin and plate fixation in complex distal humerus fractures: surgical technique and results

“…Although the preliminary results of the Locking Compression Plate (LCP) in supra-intercondylar fractures are promising with good outcome [4], and recently open reduction and internal fixation (ORIF) with the Distal Humeral Plate (DHP) system has been evaluated [5], these studies were not especially focused on very low supracondylar fractures. Some low supracondylar fractures contain small distal fragments, which are difficult to stabilise even with low twisted, multiple or anatomically pre-shaped LCP plates because there may not be enough space, even for a small number of screws in the distal fragment.…”

“…There are a number of techniques in the literature for complex fractures such as bilateral plate fixation [4], ring fixator [5], double tension band wiring (TBW) [8] and distal humeral plate [11], but there is no unique method of fixation for all complex fractures.…”

Biomechanical comparison of anatomical plating systems for comminuted distal humeral fractures

“…These features aim at rigid stability to allow early mobilization as well as adequate stiffness to stimulate fracture healing [5]. The preferred plating techniques for comminuted distal humeral fractures include the Mayo clinic configuration (180°between plates) with parallel plate fixation and medial and lateral plate positioning as well as the AO/ASIF configuration (90°angle between plates) with perpendicular plate fixation and medial and postero-lateral plate positioning [3,[6][7][8][9]. Parallel orientation of the plates seemed biomechanically superior [10], but for the translation to the clinical setting the soft tissue envelope and Patrick A. Varady and Christian von Rüden contributed equally to this work.…”