Combined Olecranon Osteotomy and the Posterior Minimal Invasive Plate Osteosynthesis Approach for a Concomitant Injury of the Humeral Shaft and a Distal Intraarticular Humerus Fracture (original) (raw)
Related papers
Intra-articular distal humerus fracture -TRAP or olecranon osteotomy
Indian Journal of Orthopaedics Surgery, 2023
Introduction: Intra-articular distal humeral fractures can be approached in a variety of ways. The purpose of this study is to evaluate and compare the functional outcomes of two approaches: one with olecranon osteotomy and other with triceps-lifting approach; for the treatment of intra-articular distal humeral fractures. Materials and Methods: In this study, 10 patients in Group A were compared with 10 patients in Group B. Both the groups were comparable in terms of age, gender, duration of injury and degree of comminution of the fracture. Results were compared in terms of operative time, hospital stay, union, range of motion and complications. Functional evaluation was done using the Mayos’ elbow performance score (MEPS). Results: Patients were followed for a minimum of 12 months. Fracture union was seen at or before 4 months in all the patients of both the groups, except in 1 case of Group A where it was seen at 7 months. Average time to union was comparable in both the groups. In Group A, mean range of flexion was found to be 118 degrees (SD 7.33) and extension lag was found to be 11 degrees (SD 3.84). In Group B, mean degree of flexion was found to be 118.25 (SD 4.94) and extension loss of 12 degrees (SD 4.70). Average range of motion was comparable in both groups. There were no significant differences noted between the two groups in terms of mean MEPS (p= 0.573). The overall complication rate was 40% in the TRAP group and 30% in the olecranon osteotomy group. Conclusion: Intra-articular distal humerus fractures mandate surgical fixation for best functional outcomes. Although technically demanding, TRAP exposure can prove to be as effective as olecranon osteotomy approach. Both approaches appear to yield no significant differences in clinical and functional results for intra-articular distal humerus fracture management. Keywords: Intraarticular distal humerus fracture, TRAP, Olecranon osteotomy, MEPS.
JPMA. The Journal of the Pakistan Medical Association, 2020
A case series was extracted from the trauma registry at Aga Khan University Hospital from the period June 2015 to June 2019. Included were 16 adult patients who presented with intra-articular distal humerus fracture type C2. The functional, clinical and radiological outcomes of fractures treated with or without olecranon osteotomy up to 12 months follow-up were compared. Outcomes were assessed at 6 weeks, 3, 6 and 12 months re-visits. Among the 16 studied patients, 9 (56%) were males and 7 (44%) were females. In the group without osteotomy, there was a good functional and clinical outcome with a mean Quick Disability of the Arm, Shoulder and Hand score of 32±30 at 3 months post-procedure. Bone healing was noticed at 6 months after surgery. In the osteotomy group, 50%-70% bone union was seen at 3 months post-surgery while fair functional and clinical outcome was achieved at 6 months after surgery.
International Journal of Orthopaedics Sciences
Introduction: Intra-articular distal humeral fractures are very complex fractures. A variety of approaches are used to treat this fracture. The purpose of this study is to evaluate and compare the functional outcomes of two approaches that are olecranon osteotomy and triceps-lifting approach for the treatment of intra-articular distal humeral fractures. Methods: This study includes 30 intra-articular distal humeral fractures patients who were treated with open reduction and internal fixation with anatomic plating by two different approaches. Lateral plating was performed in 6 patients, and medial and lateral parallel plating was performed in 12 patients in the olecranon osteotomy group, while lateral plating was performed in 3 patients, and medial and lateral parallel plating was performed in 9 patients in a triceps-lifting group. It includes retrospective and prospective study in the department of orthopaedic in DR. D Y Patil Medical College Kolhapur during the period from June 2017 to June 2019. Results: After regular follow and after assessing the patient we came to the result that functional outcomes according to MAYO elbow score and extension-flexion motion arc values were significantly better in the olecranon osteotomy group. The mean complication rate in olecranon osteotomy was 33% and in tricep lifting approach the mean complication rate was 50%. Conclusion: Olecranon osteotomy approach has better functional outcomes than the triceps-lifting approach. Intra-articular distal humerus fractures can be safely treated with olecranon osteotomy which provides more control over the elbow joint and better visualization and allows early postoperative rehabilitation.
Journal of Liaquat University of Medical & Health Sciences, 2017
INTRODUCTION: The dual plate osteosynthesis technique for fixation of inter-condylar distal humerus fracture is now considered an accepted treatment modality. It provides a rigid fixation of fracture fragments to enable early post-operative mobilization for good outcome. OBJECTIVE: The purpose of study is to assess the morbidity and clinico-radiological outcome of the dual plating osteosynthesis technique used for fixation of inter-condylar distal humerus fractures (DHF) via trans-olecranon approach METHODOLOGY: This perspective cross sectional study was carried at Department of Orthopaedic Surgery, Dow Medical College / Civil Hospital Karachi from June 2014 to March 2016. A total of 21adult patients with comminuted inter-condylar fracture of the distal humerus operated with dual plating osteosynthesis technique via trans-olecranon approach were evaluated clinically and radiologically for functional outcome based on Jupiter criteria including alignment and fracture union after a mean follow-up of 8 months. Post surgical complications were noted. Fractures were classified according to Muller et al (AO). Patients with polytrauma, pathological fracture, open fracture and a fracture more than 2 week old were excluded from the study. RESULTS: Out of the 21 patients, 38% were female and 62% were male. 52.3% had left elbow while 47.6% had right elbow involvement. The mean age was 31 years (range 20-50 years). Mean time between injury and internal fixation was 4.8 days. The mean follow-up period was 8 months. As per AO classification, 10 cases were C1, 7 cases C2 while 4 cases were in C3. The most common cause of fracture was road traffic accident in 13 cases. All fractures achieved anatomical restoration of articular surface and were united in average 14.6 weeks. The clinical results were evaluated for functional outcome based on Jupiter criteria. According to that criterion, satisfactory results were obtained in all patients. We had no instance of postoperative deep infection and neurological complications, only Backing of olecranon K-wires were noted in 5 patients (23.8%). CONCLUSIONS: We conclude that dual plate osteosynthesis technique is an effective procedure for fixation of inter-condylar distal humerus fracture, achieves rigid fixation and hence, early mobilization. Additionally use of olecranon osteotomy offers best fracture exposure of distal humerus. Complications were minimal and healing satisfactory.
Introduction: Olecranon osteotomy provides a good exposure of the fracture site for distal humerus fracture fixation. However, it is not without its potential disadvantages of delayed union, non-union at osteotomy site and other implant related complications. Triceps reflecting approaches are known to avoid these complications. The aim of our study was to compare the outcomes in the two surgical approaches by assessing the radiological union, the functional outcome by MEPI score and complications associated with each approaches. Methods: 40 consecutive patients were alternatively allotted into two groups. Group A had 20 patients treated surgically by trans-olecranon approach. Group B had 20 patients treated surgically by triceps reflecting approach. Patients were followed up for period of 24 months. Patients were assessed for stability of fixation, radiological union, the functional outcome using MEPI, and the complications in each group were reported. Results: Regardless of the fracture and implant type, functional mobility, elbow function, patient satisfaction, and quality-of-life assessments were comparable between the groups at three and twelve months. No significant differences were found in the functional outcome. But olecranon osteotomy approach group were associated with more complications Conclusion: Trans-olecranon and triceps reflecting approaches are similar in their functional outcomes but complication rates are higher in trans olecranon approach.
National Journal of Clinical Orthopaedics
Introduction: The management of distal humeral fractures has evolved over the last few years. In intra articular fracture of the lower end Humerus the primary goal is to achieve a stable and mobile elbow. Until now, disagreement has existed on how to treat these fractures in elderly patients. Recommendations range from conservative treatment to primary total elbow replacement. So far, reports in the literature on whether or not open reduction and internal fixation in these patients is justified are very rare. Materials and methods: Fifty four patients (Average age 45 years) from Jan 20013 To Dec 2014 were included in this series. There were 38 males and 16 females. Mechanism of injury was fall with back of elbow striking the ground (70%) and Road traffic accident (30%). The author has used AO classification 5 for categorizing the fractures accordingly, 10 fractures were of B2, 14 were B3, 12 were C1 type and 10 belonged to C2 and 8 belonged to C3 Type. Results and discussion: The average follow up was 16 months with a minimum of one year. 14 cases had loss of extension measuring 30 0 and less. Only 12 cases had no loss of extension. Flexion of elbow more than 1200 got recovered in 28 cases. 10 patients had pain in elbow on prolonged activity and changes in weather condition. The final evaluation showed 70 % Excellent and good results, 24% had Fair results and 6% had poor results. When "K' wire alone were used fixation was not stable enough and required longer external immobilization. And delay in start of physiotherapy with consequent loss of movements. Olecranon osteotomy gives better visualization. and reduction of fracture fragments and their articular surface. Conclusion: Rigid Anatomical Fixation & Early Mobilisation is the Key. High complications in Elderly Osteoporotic patients. Younger the patient Better the results. Communition of Fragments show increased Difficulty in Fixation, & results in loss of movements also.
Controversies in the management of intra-articular fractures of distal humerus in adults
Indian Journal of Orthopaedics, 2011
The surgical approach, type of olecranon osteotomy, method of stabilization of osteotomy, type of fracture stabilization, orthogonal vs parallel plate fixation, need for transposition of ulnar nerve, place for primary total elbow replacement, and type of rehabilitation schedule after surgical fracture treatment are the controversial issues in the treatment of complex intra-articular distal humerus fractures (C2 and C3) in adults. Severe comminution, bone loss, and osteoporosis at the site of distal articular fractures of humerus often lead to unsatisfactory results due to inadequate fixation. We hereby report the outcome of a series of intracondylar fractures of the humerus treated by open reduction and internal fixation and discuss the controversies in light of published literature. Materials and Methods: One hundred and eighty-four patients of intra-articular fractures of distal humerus (C2 and C3) were operated by posterior transolecranon approach between January 1980 and December 2008. Initially, in the first part Chevron intra-articular osteotomy (n=108) was performed out of which 94 have been published in another publication. In later second part (1993 onward), extra-articular olecranon osteotomy (n=76) was routinely performed. Both columns were stably fixed by orthogonal methods; (n=174) however, during the last 2 years, in 10 patients with severe comminution with bone loss, stabilization was achieved by parallel plating. The osteotomy was routinely stabilized by tension band wiring with two parallel K-wires introduced up to the anterior ulnar cortex. The results were evaluated by the staging system of Caja et al. at a minimum follow-up of 2 years. Results: In the first part of the study (n=94), there was delayed union in 4% (n=4), with the fracture taking more than 20 weeks for union. There was delayed union of ulnar osteotomy (n=3) and failure of one tension band wiring, requiring revision. Some loss of motion was seen in 20% of cases and these patients did not achieve full flexion and extension. However, all these patients had useful range of function, with 20°-110° of flexion and full pronation-supination. As per the staging system of Caja et al., the results were in the range of excellent to good in 72% cases (n=67), fair in 19% (n=18), and poor in 9% patients (n=9). In the second part of study (n=90) dual plate fixation of both columns by orthogonal methods (n=80) and parallel plate fixation in 10 patients was performed. The results were excellent to good in 78 patients (86%).
Annals of International medical and Dental Research, 2018
Background: This study was done for the analysis of the functional outcomes of distal humerus fractures managed by open reduction internal fixation by reviewing 24 cases of fractures of distal humerus which were surgically managed by olecranon osteotomy approach during December 2012 to September 2016. Methods: 16 male patients and 8 female patients with a mean age of 38.12±15.06 years were included in this study. A mean follow up time of 10.2months (range 3-18 months) was done. Flexion, extension, range of motion,mayo elbow performance score (MEPS),disability of shoulder arm and hand score (DASH SCORE), duration of surgery and blood loss were used to assess the functional outcome of fractures of distal humerus managed by open reduction internal fixation using the olecranon osteotomy approach. Results: According to AO foundation (AO) Classification there were no cases of type A or type B , 5 cases of type C1 , 6 cases of type C2 and 13 cases of type C3 fractures.Out of 24 patients9(37.5%), 9(37.5%), 6(25%) obtained Excellent , Good , Fair MEP score respectively. Conclusion: No patient fell under poor category of MEP score.