ORIF of Distal Humerus Fractures with Modern Pre-contoured Implants is Still Associated with a High Rate of Complications

Patel, Shaan; Mir, Hassan R.; Horowitz, Evan; Smith, Carlowen Andrew; Ahmed, Adil S.; Downes, Katheryne; Nydick, Jason A.

doi:10.1007/s43465-020-00124-4

Cited by 16 publications

(26 citation statements)

References 50 publications

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“…A comparison of our data with those of previous studies is presented in Table 2 [4,6,8]. Subgroup analysis according to xation method and surgical approach was presented in Tables 3 and 4.…”

Section: Author Contributionsmentioning

confidence: 77%

Complications associated with plate fixation for adult distal humerus fractures : A multicenter retrospective study

Han

Park

Baek

et al. 2022

Preprint

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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

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Section: Author Contributionsmentioning

confidence: 77%

Complications associated with plate fixation for adult distal humerus fractures : A multicenter retrospective study

Han

Park

Baek

et al. 2022

Preprint

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“…Sixty-one percent of the patients (11/18) underwent more than one surgery. These complications were higher than isolated olecranon fractures, distal humerus fractures, or transolecranon fracture-dislocations 2,3,6,8,13,15,25 . Also, distal humerus fractures and elbow fracture-dislocations are known to be a common source of post-traumatic elbow arthrosis due to greater severity of articular surface injury 3,24 .…”

Section: Pediatric Cohortmentioning

confidence: 84%

“…Outcomes of transolecranon fracture-dislocations [3][4][5][6] and isolated distal humerus fractures [7][8][9][10][11][12][13][14][15] have been described in the literature. The purpose of this study was to review the outcomes and complications associated with transolecranon distal humerus fractures.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2021

J Orthopedics & Orthopedic Surg

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Background: Transolecranon distal humerus fractures are uncommon injuries. The purpose of this study is to review the outcomes and complications associated with transolecranon distal humerus fractures. Material and Methods:We performed a systematic search of PubMed for articles published between 1990 and 2021. Included studies reported outcomes and complications of transolecranon distal humerus fractures. Data was extracted from the included studies to describe patient demographics, injury characteristics, outcome measurements, and complications.Results: A total of 4 studies met inclusion criteria for data extraction and analysis. Two studies evaluated an adult cohort of a total of 18 patients. The average Disabilities of the Arm, Shoulder, and Hand (DASH) score was 40 (range 4.2 -76.5). Fifteen patients (83%) had a complication. Elbow stiffness (11/18, 61%) was the most common complication. Eleven patients (61%) underwent more than one procedure. Two studies evaluated a pediatric cohort of a total of 9 patients. Five patients (56%) underwent non-operative treatment with immobilization and four patients (44%) underwent open reduction and internal fixation. There were no complications reported. All the pediatric patients regained near full range of motion of the elbow at their final follow-up. Conclusion:Transolecranon distal humerus fractures are complex elbow injuries. In the adult population, they remain a challenge for orthopaedic surgeons. Complications, including elbow stiffness and infection, are high with frequent long-term functional limitations as represented by DASH scores. In contrast, pediatric patients have good outcomes and minimal complications that are similar to isolated olecranon and distal humerus fractures in children.

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“…Factors contributing to the complexity of these fractures are the small dimension of fragments which can limit screw fixation and osteoporosis requiring implants providing good bone purchase [12,16,23,24]. Despite advances in implant design, several retrospective studies still present high complication rates, moderate functional results, and high revision rates [9,14,25]. Yetter et al reported in their systematic review and meta-analysis (83 studies) a total complication and reoperation rate of 53.4% and 20.8% in respect among 2362 elbows (83% type C and 17% type B) and follow-up times to a mean period of 2.6 years [15].…”

Section: Discussionmentioning

confidence: 99%

“…In reality, a proper anatomical reduction and adequate internal fixation can become a real challenge [4][5][6]. Despite the evolution of surgical approaches and design of elbow-specific implants in the last decades, recent studies have failed to show significantly improved outcomes [7][8][9][10][11]. Malunion, nonunion, deformity, stiffness, heterotopic ossification, and complications from the olecranon osteotomy and the ulnar nerve are consistently reported and are mainly related to cartilage loss, inadequate reduction, and suboptimal fixation [4,[12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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

Tyllianakis¹,

Solou²,

Lakoumentas³

et al. 2022

Cureus

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IntroductionTreatment of intra-articular fractures of the distal humerus is challenging due to their complexity, comminution, and associated complications. The evolution of surgical approaches and the design of elbowspecific implants over the last decades have failed to improve clinical and radiological outcomes. Studies are sparse regarding the long-term influence of surgical treatment of these types of fractures in the upper limb function. The purpose of the current study was to retrospectively review the long-term functional outcome and complications of all intraarticular (AO type B, C) distal humerus fractures treated surgically in a university hospital during the last 25 years.

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ORIF of Distal Humerus Fractures with Modern Pre-contoured Implants is Still Associated with a High Rate of Complications

Cited by 16 publications

References 50 publications

Complications associated with plate fixation for adult distal humerus fractures : A multicenter retrospective study

Complications associated with plate fixation for adult distal humerus fractures : A multicenter retrospective study

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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

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