Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation

Claessen, Femke M.A.P.; Stoop, Nicky; Ring, David; Doornberg, Job N.; Bekerom, Michel P.J. van den; Spoor, A. B.; Chauhan, Aakash; Wahegaonkar, Abhijeet L.; Shafritz, Adam B.; Miller, Anna N.; Barquet, Antonio; Kristan, Anže; Apard, Thomas; Armstrong, April; Berner, Arne; Jubel, A.; Kreis, B.E.; Babiş, Claudiu; Sutker, B.; Sears, Benjamin W.; Nolan, Betsy M.; Crist, Brett D.; Cross, Brian; Wills, Brian P.D.; Barreto, Camilo Jose Romero; Ekholm, Carl; Swigart, Carrie R.; Miranda, Cesar Dario Oliveira; Manke, C.; Zalavras, Charalampos G.; Goldfarb, Charles A.; Cassidy, Charles; Walsh, Charlotte; Jones, Colwyn; Garnavos, Christos; Young, Carolyn; Moreno-Serrano, Constanza L.; Lomita, Craig; Klostermann, C.; Deurzen, D. F. van; Rikli, Daniel; Polatsch, Daniel B.; Beingessner, Daphne M.; Drosdowech, Darren S.; Eygendaal, Denise; Patel, Minoo; Brilej, Drago; Walbeehm, Erik T.; Ballas, Efstathios G.; Ibrahim, Edward; Melamed, Eyal; Pemovska, E. Stojkovska; Hofmeister, Eric P.; Hammerberg, E. Mark; Kaplan, F. Thomas D.; Suarez, Fabio; Fernandes, Carlos Henrique; Lopez-Gonzalez, Francisco; Walter, Frank L.; Frihagen, Frede; Kraan, Gerald; Kontakis, George; Dyer, George S.M.; Kohut, George; Panagopoulos, Georgios N.; Hernández, Goretti; Porcellini, Giuseppe; Bayne, Grant; Merrell, Gregory A.; DeSilva, Gregory L.; Rocca, Guido; Bamberger, H. Brent; Broekhuyse, Henry M.; Durchholz, Holger; Kodde, Izaäk F.; McGraw, I.; Harris, Ian A.; Pountos, Ippokratis; Wiater, J. Michael; Choueka, Jack; Kazanjian, Jack E.; Gillespie, J. A.; Biert, J.; Fanuele, Jason; Johnson, Jason W.; Greenberg, Jonathan A.; Abrams, Julian A.; Hall, Jeremy A.; Fischer, J; Scheer, Johan; Itamura, John M.; Capo, John T.; Braman, Jonathan P.; Rubio, Javier García; Ortiz, Jacqueline; Filho, João Eduardo Gomes; Nolla, Jose; Abboud, Joseph A.; Conflitti, Joseph; Abzug, Joshua M.; Patiño, Juan Martín; Roiz, J.M. Rodríguez; Adams, Janet; Bishop, Jonathan; Kabir, K.; Chivers, Karel; Prommersberger, K.-J.; Egol, Kenneth A.; Rumball, Kevin M.; Dickson, Kyle; Jeray, Kyle J.; Poelhekke, L.M.S.J.; Campinhos, L. A.; Mica, Ladislav; Borris, Lars C.; Adolfsson, Lars; Schulte, Leah M.; Elmans, L.; Lane, Lewis B.; Paz, Luis H; Taitsman, Lisa A.; Guenter, L.; Austin, Luke; Waseem, Mohammad; Palmer, M. Jason; Abdel-Ghany, Mahmoud; Richard, Michael; Rizzo, Marco; Pirpiris, Marinis; Micoli, M. Di; Bonczar, M; Loebenberg, Mark I.; Richardson, Martin; Mormino, Matthew A.; Menon, M. P. A.; Soong, Maximillian; Wood, Matt; Meylaerts, S.A.G.; Darowish, Michael; Nancollas, Michael; Prayson, Michael J.; Grafe, Michael; Kessler, Michael W.; Kaminaris, M; Pirela-Cruz, Miguel A.; McKee, Michael D.; Merchant, Maqdooda; Tyllianakis, Minos; Shafi, Mohamed; Powell, Andrew; Shortt, Nick; Felipe, N. E.; Parnes, Nata; Bijlani, N.; Elias, Nelson; Akabudike, Ngozi M.; Rossiter, Nigel D.; Lasanianos, Nikolaos; Kanakaris, N.; Brink, Ole; Eerten, Percy van; Paladini, Paolo; Martineau, Paul A.; Appleton, Paul; Levin, Pavel; Althausen, Peter L.; Evans, Peter; Jebson, Peter J.L.; Krause, Pam; Schandelmaier, P.; Peters, A. C. B.; Dantuluri, Phani K.; Blazar, Philip E.; Andreas, P.; Inna, Prashanth; Quell, M.; Ramli, Roziana; Bedout, R. de; Ranade, A. B.; Ashish, S.; Smith, R. M.; Babst, Reto; Omid, Reza; Buckley, Richard; Jenkinson, Richard; Gilbert, Richard S.; Page, Richard; Papandrea, Rick F.; Zura, Robert; Gray, Randolph; Wagenmakers, Robert; Pesantez, Rodrigo; Riet, Roger van; Calfee, Ryan P.; Helden, Svenhjalmar van; Bouaicha, Samy; Kakar, Sanjeev; Kaplan, Saul J.; Scott, Fraser; Kaar, Scott G.; Mitchell, Stuart; Rowinski, Sergio; Dodds, Seth D.; Kennedy, Stephen A.; Beldner, Steven; Schepers, Tim; Guitton, Thierry G.; Gosens, Taco; Baxamusa, Taizoon; Taleb, C.; Tosounidis, Theodoros; Wyrick, Theresa; Begue, T.; DeCoster, Thomas A.; Dienstknecht, Thomas; Varecka, Thomas F.; Mittlmeier, Thomas; Fischer, Thomas J.; Chesser, T.J.S.; O'Mara, Timothy J; Bafus, T.; Siff, Todd E.; Havliček, Tomo; Sabesan, Vani J.; Nikolaou, Vasilios; Philippe, V.; Giordano, Vincenzo; Vochteloo, Anne J. H.; Batson, W. A.; Hammert, Warren C.; Satora, Wojciech; Weil, Yoram A.; Ruch, D. S.; Marsh, L.; Swiontkowski, Marc F.; Hurwit, S.

doi:10.1016/j.jhsa.2016.07.094

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…Our findings of poor association between radiographic evaluation and development of complications are in line with a recent study that confirmed that immediate post‐operative radiographs were poorly predictive of failure after distal humeral fracture repair, including when evaluated by experienced surgeons. 23 A human study specifically analyzing post‐operative radiographic factors and patient‐reported outcome after total hip replacement also demonstrated that solely relying on the analysis of plain radiographs taken before discharge to identify the cause of complications may be inadequate. 24 Similar conclusions were reached by a different study whilst investigating if post‐operative radiographs were needed or not following open reduction and internal fixation of mandibular fractures.…”

Section: Discussionmentioning

confidence: 99%

Complications after proximal abducting ulnar osteotomy and prognostic factors in 66 dogs

Danielski

Krekis²,

Yeadon³

et al. 2021

Veterinary Surgery

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Objective To report complications and prognostic factors in dogs undergoing proximal abducting ulnar osteotomy (PAUL). To evaluate the ability to predict complications on the basis of post‐operative radiographic examination. Study Design Retrospective cohort study. Animals Sixty‐six dogs. Methods Medical records of dogs treated with PAUL between 2014 and 2019 were reviewed for demographics, intraoperative findings, and post‐operative complications. Post‐operative radiographs were reviewed by two masked expert orthopedic surgeons, who were asked to predict the likelihood of major mechanical complications. The prognostic value of variables was tested with univariate and multivariable logistic regression. Inter‐investigator agreement to predict complications was evaluated with two‐by‐two tables and kappa coefficient. Results Seventy‐four PAULs in 66 dogs were included. Duration of follow‐up ranged from 12 to 75 months (median: 53 months). Post‐operative complications were documented in 19/74 limbs (16 dogs), including major complications in 13 limbs. These complications consisted mainly of non‐union (six limbs), implant failure (two limbs), and infection (two limbs) requiring revision surgery in nine limbs. Body weight was the only variable associated with an increased risk of post‐operative complications (p = .04). Agreement between expert predictions was low (respectively k = −0.08 and k = 0.11). Conclusion Major complications were reported in one fourth of limbs treated with PAUL and were more likely as body weight increased. Suboptimal plate and screw placement or osteotomy reduction on post‐operative radiographs were poorly predictive of complications. Clinical Significance Complications are fairly common after PAUL, particularly in heavier dogs, and post‐operative radiographic examination seems unreliable to predict those.

show abstract

Section: Discussionmentioning

confidence: 99%

Complications after proximal abducting ulnar osteotomy and prognostic factors in 66 dogs

Danielski

Krekis²,

Yeadon³

et al. 2021

Veterinary Surgery

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show abstract

“…However, the screws from the medial and lateral, or medial and posterolateral condyle, sometimes overlap, and suitable length screws cannot be inserted. As a result, insufficient fixation of distal fragments may cause postoperative reduction loss [ 22 , 25 , 26 ]. The simulation was useful to evaluate appropriate plate positions and to avoid the overlap of screws.…”

Section: Discussionmentioning

confidence: 99%

Development of three-dimensional preoperative planning system for the osteosynthesis of distal humerus fractures

et al. 2020

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Background: To reproduce anatomical reduction and appropriate implant placement/choices during osteosynthesis for elbow fractures, we developed a 3D preoperative planning system. To assess the utility of 3D digital preoperative planning for the osteosynthesis of distal humerus fractures, we evaluated the reproducibility of implant reduction shapes and placements in patients with distal humerus fractures. Methods: Twelve patients with distal humerus fractures who underwent osteosynthesis using 3D preoperative planning were evaluated. Reduction shapes were evaluated by the angle between the diaphysis axis and a line connecting the vertices of the medial epicondyle and the lateral epicondyle (epicondyle angle), and the angle between the diaphysis axis and the articular surface (joint angle) in the coronal plane, and the distance between the anterior diaphysis and the anterior articular surface in the sagittal plane (anterior distance) based on 3D images of the distal humerus. In addition, the implant positions were evaluated by the positions of the proximal and posterior edge of the plate, and the angle of the plate to the epicondyle line. The reproducibility was evaluated by intra-class correlation coefficients of the parameters between pre-and postoperative images. Results: The intra-class correlation coefficients were 0.545, 0.802, and 0.372 for the epicondyle angle, joint angle, and anterior distance, respectively. The differences in the measurements between the preoperative plan and postoperative reduction were 2.1 ± 2.1 degrees, 2.3 ± 1.8 degrees, and 2.8 ± 2.0 mm, for the epicondyle angle, joint angle, and anterior distance, respectively. The intra-class correlation coefficients were 0.983, 0.661, and 0.653 for the proximal and posterior plate positions, and the angle to the epicondyle, respectively. The differences in the measurements between the preoperative plan and postoperative reduction were 3.3 ± 2.1 mm, 2.7 ± 1.7 mm and 9.7 ± 9.8 degrees, for the plate positions of proximal and posterior edge, and the angle of the plate to the epicondyle line, respectively. There were significant correlations for the epicondyle angle, joint angle, and plate positions. Conclusions: 3D preoperative planning for osteosynthesis of distal humerus fracture was reproducible for the reduction shape of the coronal view and the plate positions.

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Effect of trochleocapitellar index on adult patient-reported outcomes after noncomminuted intra-articular distal humeral fractures

Rollo

Rotini

Eygendaal

et al. 2018

Journal of Shoulder and Elbow Surgery

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Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation

Cited by 3 publications

References 17 publications

Complications after proximal abducting ulnar osteotomy and prognostic factors in 66 dogs

Complications after proximal abducting ulnar osteotomy and prognostic factors in 66 dogs

Development of three-dimensional preoperative planning system for the osteosynthesis of distal humerus fractures

Effect of trochleocapitellar index on adult patient-reported outcomes after noncomminuted intra-articular distal humeral fractures

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