Temporary spanning plate across the elbow for complex fractures of the distal humerus

Abstract

Background Open reduction internal fixation (ORIF) is the gold standard management of fractures of the distal humerus. Stable fixation to allow early mobilization is not always possible in cases with comminuted fracture patterns and bone loss, with a high failure rate. We propose augmentation of internal fixation in these unstable situations with a spanning plate across the elbow to protect the fixation construct temporarily until bone union. Methods Eighteen patients with complex distal humeral fractures were managed with standard ORIF technique augmented with a temporary plate spanning across the elbow as an internal fixator. Cases included were either very distal, comminuted (6 cases) or insufficiency fractures (4 cases) or revision fixation cases (8 cases). The temporary spanning plate was removed as soon as signs of early radiographic union were detected. Results Seventeen patients were available for final follow up at a mean 28.3 months. The spanning plate was removed after 3.4 months on average. At the final follow-up, the mean elbow total arc of motion was 86.3°. The mean Mayo Elbow Performance Score (MEPS) was 80, and the mean Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score was 27. Conclusion Spanning the elbow temporarily with a plate in adjunct to standard ORIF technique is both simple and effective in achieving fracture stability and union and minimizes failure rates after fixation of comminuted, very distal fractures, osteoporotic cases, or revision fixation cases with bone loss. Level of evidence Level IV, Therapeutic study

Three-dimensional printing designed customized plate in the treatment of coronal fracture of distal humerus in teenager: A case report

“…With poor stability and difficulty in resisting the shear stress generated by the joint., [ 3 ] the cannulated screw would probably result in internal fixation failure and delayed healing, and even nonunion with necrosis of the distal humeral articular surface and elbow joint disability, and osteoarthrosis of the elbow. [ 12 ]…”

“…With poor stability and difficulty in resisting the shear stress generated by the joint., [3] the cannulated screw would probably result in internal fixation failure and delayed healing, and even nonunion with necrosis of the distal humeral articular surface and elbow joint disability, and osteoarthrosis of the elbow. [12] However, functional exercises within 3 weeks after surgical treatment is the key factor for functional recovery of the elbow joint. [8,13] Studies have shown that the probability of elbow stiffness after trauma is at least 5%, and if the range of motion of the elbow is less than 30° to 120°, it will seriously affect orthobiosis.…”

Conversion from Spanning External Fixation to Open Reduction Internal Fixation Contributes to Healing of Soft Tissues and Fractures in Open Distal Humeral Fractures

“…ORIF treatment for DHFs with an extensor mechanism-on approach can achieve favorable healing, a mean elbow flexion-extension exceeding 100°, and maintenance of 90% of elbow extension strength, relative to that of the contralateral, normal elbow [ 4 ]. Spanning the elbow temporarily with a plate as an adjunct to the ORIF method has been demonstrated to be simple and effective in achieving fracture stability and union and can minimize failure rates after fixation of DHFs [ 16 ]. However, a recent systematic review and meta-analysis revealed that complications and reoperations of DHFs after ORIF may be more frequent than previously understood [ 17 ].…”