The functional and radiological outcome of open reduction and internal fixation of comminuted intra-articular distal humerus fracture with bi-columnar plating technique in adults

Abstract

Recent studies have emphasised the importance of surgical approach, anatomical reconstruction, rigid fixation and early rehabilitation for good outcome. Hence the present study was planned to evaluate the outcome of surgical treatment of comminuted intra-articular distal humerus fractures fixed with bicolumnar plating technique. All the fractures were fixed using the AO bi-columnar plating techniques with distal humerus locking plates or reconstruction plates, fifteen cases via olecranon osteotomy approach and seven fractures fixed by triceps reflecting anconeus pedicle (TRAP) approach. Physiotherapy was started from 1st post-op day with unprotected ROM exercises were allowed by 3rd week. Patients were followed up at 6 weeks, 3 months, 6 months interval. Clinical outcome was assessed using MEPI (Mayo Elbow Performance Index) score and radiologically assessed for reduction, alignment, fracture union, post traumatic arthritis, and heterotopic ossification. The mean MEPI score was 90.45 points (range, 0 to 100 points), indicating mild impairment. Radiological union was achieved in 18.18% of patients at one and half month intervals whereas 81.82% of patients had radiological union during third month with average time for union being 10.9 weeks. We conclude that open reduction internal fixation of comminuted intra-articular fractures of the distal humerus with bicolumnar plating technique is an effective procedure with an excellent outcome in 54.5%, good outcome in 27.3% and fair outcome in 18.2% of patients in most age groups according to MEPI scoring. Patients have a high level of satisfaction and the majority return to their previous level of activity.