Complications associated with open reduction and internal fixation for adult distal humerus fractures: a multicenter retrospective study

Abstract

Background Open reduction and plate fixation are the preferred treatment options for most distal humerus fractures in adults. However, it is often challenging for orthopedic surgeons because of the complex anatomy and the difficulty in achieving stable fixation. This multicenter study aimed to analyze the complication types and rates of patients with distal humerus fractures treated with open reduction and plate fixation, and compare the results with those found in the literature. In addition, we describe the clinical outcomes. Methods This retrospective multicenter study was conducted between September 2001 and March 2021 and included data from four hospitals. In total, 349 elbows underwent surgical treatment at these hospitals during the study period. Patients > 17 years of age who were treated by plate fixation were included, and patients who were treated by other fixation methods were excluded. A total of 170 patients were included in the study. The following types of complications were investigated: (1) nerve related; (2) fixation and instrument related; (3) osteosynthesis related; (4) infection; and (5) others. Results The following complications were found: (1) 26 (15.3%) cases of postoperative ulnar nerve symptoms; 4 (2.4%) of postoperative radial nerve symptoms; (2) one (0.6%) case of screw joint penetration and screw loosening; and eight (4.7%) cases of hardware removal due to instrument skin irritation; (3) seven (4.1%) cases of nonunion; (4) two (1.2%) and four (2.2%) cases of superficial and deep infection, respectively, and seven (3.9%) cases of wound complication; and (5) 37 (21.8%) cases of heterotrophic ossification, 79 (46.5%) cases of elbow stiffness (did not achieve functional range of motion [ROM]), and 41 (24.1%) cases of osteoarthritis over Broberg and Morrey Grade I. Paradoxically, the postoperative ulnar nerve symptoms were more frequent in the prophylactic ulnar nerve anterior transposition group. However, this difference was not statistically significant (p = 0.086). The mean ROM was 123.5° flexion to 9.5° extension. The average Disabilities of the Arm, Shoulder and Hand (DASH) score was 14.5 ± 15.6. Conclusions Open reduction and plate fixation for distal humeral fractures is a reasonable treatment option with acceptable complication rates and favorable clinical outcomes. Surgeons must be vigilant about ulnar nerve complications. Level of Evidence Therapeutic Level III.

Weak Points of Double-Plate Stabilization Used in the Treatment of Distal Humerus Fracture through Finite Element Analysis

“…As mentioned earlier, ensuring an appropriate level of bone fragment mutual displacement is one of the key conditions for achieving proper bone union [33,34]. In this situation, the excessive mutual displacement of the fragments may result in bone non-union, causing frequent complications in DHF treatment [7,8,35]. Helfet et al [36] analyzed the treatment outcomes of patients with previous distal humerus fracture non-union.…”

“…The gold standard in DHF surgical treatment is open reduction and internal fixation (ORIF), which 2 of 16 uses two locking plates and a set of screws [4,5]. However, the use of double-plating in DHF osteosynthesis still results in a high complication rate, estimated to affect over 50% of all operated patients [6][7][8][9]. The most common complications are the need for reoperation due to, for example, deep infection or painful implant (20.8-49%); non-union, occurring when the fracture is not clinically or radiographically united after 6 months of fixation (4.1-9.3%); stiffness of the elbow joint, diagnosed, for example, when the patient cannot achieve a 30 • -130 • arc (19-46.5%); or degenerative changes, e.g., osteoarthritis (9-21.1%) or heterotrophic ossifications (5.1-21.8%).…”

Analysis of the associated factors in postoperative wound infection following open reduction and internal fixation for elbow fracture

“…This understanding is not only vital for mitigating risks but also for enhancing the overall efficacy of the surgical intervention. 9 The current study aims to conduct an in-depth analysis of these factors, providing valuable insights that can inform both clinical practice and future research in orthopaedic surgery.…”

“…This realisation underscores the necessity of our study, which seeks to bridge the gap between understanding these risk factors and applying this knowledge to improve clinical outcomes. This understanding is not only vital for mitigating risks but also for enhancing the overall efficacy of the surgical intervention 9 . The current study aims to conduct an in‐depth analysis of these factors, providing valuable insights that can inform both clinical practice and future research in orthopaedic surgery.…”