Fractures of the distal humerus in elderly patients treated with a ring fixator

Abstract

The aim of distal humerus fracture treatment is articular surface reduction and stable fixation for early mobilisation and rehabilitation. This is usually performed by open reduction and internal fixation with plates. In the elderly osteoporotic patient this treatment is difficult to achieve due to fixation failure in fragile bone. We present our experience with treatment by closed reduction and external fixation with a non-bridging ring fixator in distal humerus fractures in elderly patients. There were ten females, aged 70-89 (average 78.4). Fracture types (AO/ ASIF) included three supracondylar fractures (type A) and seven intercondylar fractures (type C). All patients were treated by closed reduction and external fixation with a non-bridging ring fixator of the distal humerus and immediate postoperative mobilisation of the elbow. External fixation was removed on an average of 72 days (range 62-90). All fractures united. Average time to union was 56 days. Average range of movement at six months was 22°e xtension lag (range 15°-30°) and 115°flexion (range 110°-120°). Complications included one patient with transient radial palsy and one patient with a superficial decubitus ulcer on the chest wall from the hardware. Minimally invasive treatment by closed reduction and external fixation with a ring fixator is effective for treatment of fractures of the distal humerus in elderly patients with osteoporotic bone. This treatment enables immediate mobilisation of the elbow, and allows return to function. It should be considered an alternative to open reduction and internal fixation or total elbow replacement.

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

“…He noted that failure of fixation typically occurs in the distal fragment [14] which is more likely in low fractures. Alternatively, some reported placing the plates as distal as possible or adding an intermediate third or fourth plate if reconstruction with two plates is inadequate despite good bone stock [5]. Greiner et al reported preliminary results of the LCP in supra-intercondylar fractures and noted that clinical and radiological results are promising with good outcome [6].…”

“…Only two patients had heterotopic ossifications Brooker types I and II [7] Discussion Fractures involving the distal humerus are difficult to manage because of the complex anatomy. Many techniques have been described in the fixation of distal humerus fractures, such as double TBW [8], Y-plating [9], orthogonal plating, parallel position of the plates [10] and the DHP system [5].…”

“…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.…”

Distal humeral fractures: fixation versus arthroplasty

“…11 Elderly patients with fractures of the distal humerus have been treated with a ring fixator with satisfactory results. 7 External fixation may be mandated by a grade 3 open fracture of the distal humerus (Fig. 4).…”