Long-Term Functional Outcomes and Complications of Intra-Articular (AO type B, C) Distal Humerus Fractures in Adults: A Retrospective Review

Tyllianakis, Minos; Solou, Konstantina; Lakoumentas, John; Panagopoulos, Andreas

doi:10.7759/cureus.21094

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…The duration of hospital stay in the TRAP group was significantly higher than that of the olecranon osteotomy group because the patients in the TRAP group were not mobilized until after 7 d after the removal of the slab. The time taken for radiological union (10-16 wk) in our study was comparable to the other studies irrespective of the approach used[ 5 , 10 , 19 , 20 ]. In this study, the complication rate was similar in both groups except for hardware prominence, which was significantly higher in the olecranon osteotomy group.…”

Section: Discussionsupporting

confidence: 84%

Clinical outcomes of triceps reflecting anconeus pedicle and olecranon osteotomy approach for distal humerus intercondylar fractures

Ailani,

Bhuyan,

Prasad

et al. 2024

World J Orthop

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BACKGROUND The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation. While there is consensus about the posterior approach, several posterior approaches have been developed. It is debatable as to which approach is best. AIM To compare triceps reflecting anconeus pedicle (TRAP) and olecranon osteotomy approaches for internal fixation of distal humeral intercondylar fracture. METHODS In total, 40 cases of Arbeitsgemeinschaft für Osteosynthesefragen/Association of the Study of Internal Fixation type C, closed, and Gustilo type I intercondylar humeral fractures were included. Patients ranged in age from 18 years to 70 years. The patients were randomized into two groups: TRAP group and olecranon osteotomy group, with 20 cases in each. All were followed up at 6 wk, 3 months, 6 months, and 12 months. Functional outcomes were measured in terms of flexion-extension arc, Disabilities of Arm, Shoulder and Hand score, and Mayo Elbow Performance Score. RESULTS The mean age was 43.2 years in the TRAP group and 37.5 years in the olecranon osteotomy group. The mean operative time and mean duration of hospital stay in the TRAP group were significantly higher than in the olecranon osteotomy group (119.5 vs 111.5 min and 9.85 vs 5.45 d, respectively). The mean arc of flexion-extension, Disabilities of Arm, Shoulder and Hand score, and Mayo Elbow Performance Score were comparable without any significant difference in the groups at the 12-month follow-up (107.0 vs 106.2, 18.3 vs 15.7, and 84.2 vs 86.2, respectively). Ulnar paresthesia and superficial infections were comparable in both groups (2 cases vs 3 cases and 3 cases vs 2 cases, respectively). Hardware prominence was significantly higher in the olecranon osteotomy group, mostly due to tension band wiring. CONCLUSION Both approaches were equivalent, but there is a need for further study including higher numbers of subjects and longer study duration to prove the benefits of one approach over the other.

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Section: Discussionsupporting

confidence: 84%

Clinical outcomes of triceps reflecting anconeus pedicle and olecranon osteotomy approach for distal humerus intercondylar fractures

Ailani,

Bhuyan,

Prasad

et al. 2024

World J Orthop

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“…Dealing with such fractures can be very challenging due to the intricate anatomy of the elbow and small fracture fragments. In adults, the gold standard treatment for the distal humerus fractures is considered to be the open reduction internal fixation (ORIF) with plate fixation of both columns (7,8) .…”

Section: Introductionmentioning

confidence: 99%

Treatment of Supracondylar Humerus Fracture in Adults by Parallel Plates

Khater

El-Shoura

Hassan

2023

SJMS

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Objective: The aim of this study was to evaluate the outcome of parallel plates for the treatment of supracondylar humerus fractures in adults. Patients and Methods: This study included 20 adult patients with supracondylar humerus fractures. They were treated by open reduction and internal fixation by parallel plates through olecranon osteotomy technique. They were followed up clinically and radiologically for 6 months. On admission, all were assessed by careful history taking and detailed clinical examination. The preoperative radiological workup was performed by antero-posterior and lateral radiographs of the elbow with traction and computed tomography was performed with three-dimensional reconstruction. Postoperative, patients were assessed after 2, 4, 8, 12 weeks and 6 months of surgery, with clinical and radiological evaluations and assessed for pain, swelling, range of joint motion and radiological union. The functional assessment of the patient was done according to Mayo elbow performance index and the outcome was graded into excellent, good, poor and fair. RESULTS: The excellent outcome was achieved among 55.0%, while 30.0% had good, 10% had fair and 5.0% had poor outcome. The overall complication rate was 30.0% and the commonest were pain and stiffness (15.0% for each). The mean±SD times to clinical and radiological union were 12.75 ± 6.44 and 14.70 ± 7.84 weeks, respectively. The excellent outcome was significantly associated with lower rate of complications and shorter time to clinical and radiological union. CONCLUSION: Parallel plates for the treatment of adult supracondylar humerus fractures could be considered safe and effective technique, leading to good functional outcome and a complication rate comparable to published literature.

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Posterolateral Locked Plate and Percutaneous Medial Screw Fixation for Distal Humerus Fractures in Elderly

KUWAHARA,

HARA,

KURAHASHI

et al. 2024

J Hand Surg Asian-Pac Vol

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Background: A high incidence of ulnar nerve-related complications has been reported in open reduction and internal fixation for distal humerus fractures (DHFs). To minimise ulnar nerve damage, we used a percutaneous medial screw combined with a posterolateral plate in the elderly. The aim of this study was to evaluate the postoperative complications and functional outcomes of this method. Methods: Data from patients aged over 65 who underwent this surgical procedure for DHFs at a single Level I trauma centre from 2013 to 2021 were extracted. Postoperative complications, reoperations, mean range of motion, Mayo Elbow Performance Index (MEPI) scores and Hand20 scores were retrospectively evaluated. All patients in this study received postoperative rehabilitation by hand therapists at our hospital. Results: We identified 28 patients treated with this method. The mean follow-up period was 8.6 ± 3.7 months. The median intraoperative time was 125 minutes (interquartile range: 105–157 minutes). None of the patients developed ulnar nerve neuropathy, but one patient (3.7%) experienced radial nerve dysfunction. Two patients (7.4%) had nonunion. Implant failure occurred in three patients (11.1%) due to migration of the medial screw. One patient (3.7%) amongst them underwent reoperation. The mean flexion to extension arc was 97 ± 18°, 116 ± 19°, and 116 ± 19° at 1-, 3- and 6-month follow-ups, respectively. According to the MEPI, 20 patients achieved excellent results, seven patients achieved good results and one patient achieved a fair result at the last follow-up. The median Hand20 score was 4.3 (interquartile range: 2.1–14.0) at the 6-month follow-up. Conclusions: The posterolateral plate and medial screw method showed good functional outcomes and few nerve-related complications. This modified method might be a better option for DHFs in elderly patients. Level of Evidence: Level IV (Therapeutic)

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Long-Term Functional Outcomes and Complications of Intra-Articular (AO type B, C) Distal Humerus Fractures in Adults: A Retrospective Review

Cited by 3 publications

References 25 publications

Clinical outcomes of triceps reflecting anconeus pedicle and olecranon osteotomy approach for distal humerus intercondylar fractures

Clinical outcomes of triceps reflecting anconeus pedicle and olecranon osteotomy approach for distal humerus intercondylar fractures

Treatment of Supracondylar Humerus Fracture in Adults by Parallel Plates

Posterolateral Locked Plate and Percutaneous Medial Screw Fixation for Distal Humerus Fractures in Elderly

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