Outcome of anatomic locking plate in extraarticular distal humeral shaft fractures

Abstract

Background:Extraarticular fractures of distal humerus are challenging injuries to treat because of complex anatomy and fracture patterns. Functional bracing may not provide adequate stability in these injuries and operative treatment with intramedullary nails or conventional plates also has the limitation of inadequate fixation in the short distal fragment. The 3.5 mm precontoured single column locking plate (extraarticular distal humerus plate [EADHP]) has been introduced to overcome this problem. We evaluated the clinical and functional outcomes of treating these fractures with the EADHP.Materials and Methods:26 patients with extraarticular fractures of distal humerus presenting within 3 weeks of injury between January 2012 and June 2015, were included in this prospective study. Open IIIB and IIIC fractures, nonunions, or those with a history of previous infection in the arm were excluded. Operative fixation was done using the EADHP in all the cases. The time for union, range of motion at shoulder and elbow and secondary procedures were recorded in followup. The shoulder and elbow function was assessed using the University of California Los Angeles (UCLA) shoulder scale and Mayo Elbow Performance Score (MEPS) respectively.Results:There were 21 males and 5 females with mean age of 37.3 years (range 18–72 years). Twenty two (84.6%) cases had complex fracture patterns (AO/OTA Type 12-B and C). The mean time to fracture union was 22.4 weeks (range 16–28 weeks). The mean followup time was 11.6 months, (range 4-24 months). Four patients (15.4%) had failure of cortical screws in the proximal fracture fragment, of which two required revision fixation with bone grafting. Another nonunion was seen following a surgical site infection, which healed after wound lavage and bone grafting. The MEPS (average: 96.1; range 80–100) was excellent in 81% cases (n = 21) and good in 19% cases (n = 5). UCLA score (average: 33.5; range 25-35) was good/excellent in 88.5% cases (n = 23) and fair in 11.5% cases (n = 3).Conclusion:EADHP is a reliable option in treating extraarticular distal humeral fractures as it provides stable fixation with an early return to function.

Functional outcome of locking anatomical plate in extra articular fractures of the distal humerus

“…16,17 Other plate designs like the Lambda plate and metaphyseal locking plate have also been described, but none of them are as efficient as the EADHP in terms of biomechanical stability and lesser complications. [18][19][20] In our study, 30 patients were males indicating the higher incidence of distal humerus fractures in males than in females. Most of the fractures occurred due to high energy trauma i.e.…”

“…The authors concluded that EADHP is a reliable option for treatment of these fractures with stable fixation which gives early return to function. 20 There are numerous other studies which document the efficiency of this plate in treatment of distal humerus fractures. 17,22 The limitations of our study are small sample size and lack of a control group to compare the results.…”

Outcome of Extra-Articular Distal Humerus Fractures Fixed by Single Column Extra-Articular Distal Humerus Locking Compression Plate Using Triceps Sparing Postero-Lateral Approach

“…Similarly, in our series, 60% EADHF were wedge or complex type. Kharbanda Y et al and Jain D et al respectively had 75% and 84.6% of patients in their series having a wedge fragment or complex type of fracture pattern [ 4 , 21 ]. Incidence of distal humeral fractures is on rise due to high velocity road traffic accidents and the elderly women with osteoporosis is the most vulnerable group [ 21 , 22 ].…”

Technical tip: fixation of extra-articular fractures of distal humerus with modified distal tibial locking plate

“…Scolaro described the use of a pre-contoured distal humerus locking plate for distal humerus extraarticular fractures ( Figure 5D) [11]. Also, Jain et al used an extra articula posterolateral locking plate and reported a reoperation rate of 15.4% [3].…”

“…Optimal treatment of these injuries is surgical, providing a predictable alignment quicker return to pre injury status [2] Stable fixation and reduced surgical time lead to fewer complications and allow earlier rehabilitation leading to a more predictable result. In the the clinical and functional outcomes using the extraarticular distal humerus plate in the management of extraarticular fractures of distal humerus were studied [3]. Anatomy of distal humerus is complex, and often the fracture pattern adds o the complexity of situation [4].…”