Operative Management of Intra - Articular Distal Humeral Fractures With Locking Plates

Abstract

BACKGROUND: Intra-articular distal humeral fractures are common, but complex elbow injuries. To obtain good results, anatomical reduction with rigid fixation and early range of mobilization is required. Treatment of these fractures with conventional plates is associated with many complications such as non-anatomic reduction of articular surfaces, malunion, nonunion, loosening of implant, residual stiffness of the elbow and post-traumatic osteoarthrosis. In this situation the application of locking plates having a fixed angle plate screw construct can minimise most of the above complications. OBJECTIVE: To evaluate radiological and functional outcome of locking plate application for the management of intra-articular distal humeral fractures. MATERIAL AND METHODS: This prospective study was conducted from January 2013 to December 2014. We operated 20 patients of AO type-C intra-articular distal humeral fractures. Fracture was exposed using modified Campbell's posterior approach in less comminuted fractures and a V-shaped Olecranon osteotomy was done to get better exposure of the articular surface in cases with severe articular comminution. The fracture was stabilized using an intercondylar screw, pre-contoured locking compression plates and/or locking reconstruction plates as per preoperative planning. Patients were reviewed at monthly interval for clinicalradiological evaluation. Final outcome measures included radiological assessment, range of motion and Mayo elbow performance score (MEPS). RESULTS: All the fractures were united at an average 12 weeks. Two patients developed numbness in the distribution of ulnar nerve and one patient developed superficial infection in immediate postoperative period. None of the patients had malunion and loosening of implant. The average arc of flexion-extension was 105`, although no patient had loss of supination/pronation. Mayo Elbow Performance Score was excellent in 15 (75%), good in 3 (15%), fair in 1 (5%) and poor in 1 (5%). CONCLUSION:The locking plate is a useful implant for the treatment of complete articular (type-c) distal humeral fractures.

Functional outcome evaluation of distal humerus fracture fixation

“…These finding were consistent with other studies. We had no ulnar neuropraxia, and heterotrophic ossification complication which were reported in other studies by Mishra et al, Singh et al, Kaiser et al [3][4][5][6][7][8][9][10] Functional evaluation was done with mayo elbow performance score in our study. Results were excellent and good in 83% of patients, fair (10%) and poor (7%).…”

“…Average age of patients in our study was 37.5 years which is comparable with other studies 36 years by Mishra et al, 37.5 years by Singh et al, and 38.4 by Gupta et al years. [3][4][5] We found male population affected more in our study, i.e., active working population. This is in consistence with other studies like 66.7% by Atalar et al and 60% by Lakhey et al 6,7 Mode of injury in our study was road traffic accident which differs from other studies like fall in Li et al and Muzaffar et al studies.…”

“…4 The results were same and consistent with Mishra et al, Jung et al with excellent and good 90% and 81.6%, fair (5%, 13.2%) and poor (5%, 5.3%) respectively. 3,11…”

Functional outcome of distal humerus fracture in adults followed with bicolumnar fixation: A prospective study

“…The resultant mean range of elbow motion was 116 degrees at the final follow up, which nearly identical with the study by Imran mang et al (2014) [18] where they achieved mean elbow range of motion of 110. Abilhek Mishra [24] et al in their study complication rate was 15% with 2 (10%) cases of transient ulnar neuropraxia and 1(5%) case of superficial infection. Muzaffar N et al (2014) [21] in their study encountered 4(16%) cases of superficial infection; 1(4%) case of Ulnar neuropraxia 2(8%) had metal prominence (olecranon K-wires).…”

A study of functional outcome of distal humerus fractures managed by locking compression plate

“…In our study there were 15(75%) males and 5(25%) females, which is comparable with the studies conducted by Kiran G U et al 107 and Riyaz sheik et al109 which showed 14 (70%) males and 6(30%) females and also with the study conducted by Ata Can Atalar et al72 which showed 14 (66.67%) males and 7(33.33%) females In our study excellent results were found in 75%, good results in 15%, fair in 5% and poor results in 5% cases. Abilhekh Mishra et al [16] in their study of 20 patients found the results as excellent in 15(75%), good in 3(15%), fair in 1(5%) and poor in 1(5%) Imran mang et al [13] in their study of 25 patients found excellent results in 12(48%), good in 8(32%), fair in 3(12%) and poor in 2(8%) Singh V. [15] et al 106 in their study of 27 patients found the results as excellent in 4(14.81%), good in 13(48.14%), fair in 7(25.9%) and poor in 3(11.11%) Our study is closely comparable with these above mentioned studies.…”