Sanchez-Sotelo, J Bone Joint Surg Am 2007 - Complex Distal Humeral Fractures: Internal Fixation with a Principle-Based Parallel-Plate Technique

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Complex Distal Humeral Fractures: Internal Fixation with a Principle-Based Parallel-Plate Technique

Sanchez-Sotelo, O'Driscoll, et al.·J Bone Joint Surg Am·2007·189 citations·Case series

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Background

Severe comminution, bone loss, and osteopenia at the site of a distal humeral fracture increase the risk of an unsatisfactory result, often secondary to inadequate fixation. The purpose of this study was to determine the outcome of treating these fractures with a principle-based technique that maximizes fixation in the articular fragments and stability at the supracondylar level.

Methods

34 consecutive complex distal humeral fractures were fixed with 2 parallel plates applied (medially and laterally) in approximately the sagittal plane.
The technique was specifically designed to satisfy 2 principles: (1) fixation in the distal fragments should be maximized and (2) screw fixation in the distal segment should contribute to stability at the supracondylar level.
26 fractures were AO type C3, and 14 were open.
32 fractures were followed for a mean of 2 years.
The patients were assessed clinically with use of the Mayo Elbow Performance Score (MEPS) and radiographically.

Results

Neither hardware failure nor fracture displacement occurred in any patient.
Union of 31 of the 32 fractures was achieved primarily.
5 patients underwent additional surgery to treat elbow stiffness.
There was one deep infection that resolved without hardware removal and did not impede union.
At the time of the most recent follow-up, 28 elbows were either not painful or only mildly painful, and the mean flexion-extension arc was 99 degrees .
The mean MEPS was 85 points.
The result was graded as excellent for 11 elbows, good for 16, fair for 2, and poor for 3.

Conclusions

Stable fixation and a high rate of union of complex distal humeral fractures can be achieved when a principle-based surgical technique that maximizes fixation in the distal segments and stability at the supracondylar level is employed. The early stability achieved with this technique permits intensive rehabilitation to restore elbow motion.

Copyright remains with the authors and publisher.

Complex Distal Humeral Fractures: Internal Fixation with a Principle-Based Parallel-Plate Technique.

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Complex Distal Humeral Fractures: Internal Fixation with a Principle-Based Parallel-Plate Technique

Sanchez-Sotelo, O'Driscoll, et al.·J Bone Joint Surg Am·2007·189 citations·Case series

|

Background

Severe comminution, bone loss, and osteopenia at the site of a distal humeral fracture increase the risk of an unsatisfactory result, often secondary to inadequate fixation. The purpose of this study was to determine the outcome of treating these fractures with a principle-based technique that maximizes fixation in the articular fragments and stability at the supracondylar level.

Methods

34 consecutive complex distal humeral fractures were fixed with 2 parallel plates applied (medially and laterally) in approximately the sagittal plane.
The technique was specifically designed to satisfy 2 principles: (1) fixation in the distal fragments should be maximized and (2) screw fixation in the distal segment should contribute to stability at the supracondylar level.
26 fractures were AO type C3, and 14 were open.
32 fractures were followed for a mean of 2 years.
The patients were assessed clinically with use of the Mayo Elbow Performance Score (MEPS) and radiographically.

Results

Neither hardware failure nor fracture displacement occurred in any patient.
Union of 31 of the 32 fractures was achieved primarily.
5 patients underwent additional surgery to treat elbow stiffness.
There was one deep infection that resolved without hardware removal and did not impede union.
At the time of the most recent follow-up, 28 elbows were either not painful or only mildly painful, and the mean flexion-extension arc was 99 degrees .
The mean MEPS was 85 points.
The result was graded as excellent for 11 elbows, good for 16, fair for 2, and poor for 3.

Conclusions

Stable fixation and a high rate of union of complex distal humeral fractures can be achieved when a principle-based surgical technique that maximizes fixation in the distal segments and stability at the supracondylar level is employed. The early stability achieved with this technique permits intensive rehabilitation to restore elbow motion.

Copyright remains with the authors and publisher.

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