Distal Articular Fractures of the Humerus: Surgical Approach with Dynamic Elbow external Fixator (original) (raw)
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Background: Intra-articular distal humerus fractures comprise 1% of all fractures in adults1. Recent studies have emphasised the importance of surgical approach, rigid fixation and early rehabilitation for good outcome. Objectives: To assess the anatomical reduction of distal humeral articular surface by radiological examination and stability of the elbow by the functional assessment over a period of 1 year. Methodology: Thirty consecutive patients with distal humerus fractures were treated from October 2012 to October 2014 .The fractures were fixed using AO double column (orthogonal) plating techniques. Physiotherapy started from 3rd day post-op. Patients were followed at 6weeks, 3 months, 6 months, 1 year interval. Clinical outcome assessed using MEPI (Mayo Elbow Performance Index) score and radiologically assessed for reduction, alignment, fracture union, and complications. Results: All patients had completed postoperative physical therapy at the time of the study and had achieved maximum function of elbow. The mean duration of follow-up was 12 months. The mean arc of flexion was 106°. Mean pronation was 76° and supination was 77°. The mean MEPI score was 95.1 points (range 0 to 100 points), indicating mild impairment. Radiographic evidence of fracture union was noted in all patients. Conclusion: We conclude that internal fixation of intra-articular fractures of the distal humerus is an effective procedure with an excellent functional outcome in most patients. Patients have a high level of satisfaction and the majority return to their previous level of activity.
Results after internal fixation of humerus distal fractures in patients aged over 65 years
Revista Española de Cirugía Ortopédica y Traumatología (English Edition), 2014
Introduction and objective: Distal humerus fractures in the elderly frequently associated with poor bone quality and comminution, making it harder to achieve proper osteosynthesis. Our aim is to evaluate the radiological and functional results of open reduction and internal fixation of these fractures. Material and methods: Retrospective study of 26 patients treated by open reduction and internal fixation between the years 2005 and 2010. Mean follow-up was 42 months. At final follow-up, a radiography evaluation (Knirk and Jupiter score) and clinical examination using Mayo Elbow Performance Score and Quick-Disabilities of the Arm, Shoulder and Hand Score was performed. Mean age of the group was 76.8 years (65-89), with 83% of the patients being female. Sixteen patients suffered type C fractures and 8 type A by AO classification. All underwent posterior surgical approach. Results: Mean elbow flexion reached 118.86 • , with a mean extension deficit of 25 •. More than 3 quarters (79.1%) of the patients showed 0-1 grade degenerative changes on the X-ray films at final follow-up. Functional results reached an average 19.87 points on Quick-Disabilities of the Arm, Shoulder and Hand Score, and 85 points on Mayo Elbow Performance Score. Nonunion occurred in 2 cases: distal humerus in one patient and olecranon osteotomy in another. Ulnar nerve neuropraxia was recorded in 2 cases, and radial nerve in one. All 3 recovered uneventfully. Revision surgery was required, with 2 patients needing hardware removal and one a new fixation. Discussion: Treatment by open reduction and internal fixation with plating in elderly people for type A and C distal humerus fractures gives good functional results regarding this population, and thus scarcely disturbs their quality of life.
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%).
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.
Acta bio-medica : Atenei Parmensis, 2016
BACKGROUND The treatment of complex distal humerus fractures is challenging and is often associated with unsatisfactory results. Anatomic reduction and stable internal fixation is difficult to obtain, especially in elderly osteoporotic patients. For these reasons, total elbow arthroplasty (TEA) has recently evolved as a valid procedure in selected cases following these injuries. The aim of this study was to analyze outcomes of TEA for the treatment of complex distal humerus fractures in 20 low-demanding patients over 65 years of age. MATERIALS AND METHODS All patients, at a mean follow-up of 60 months, were evaluated clinically using the Mayo Elbow Performance Score (MEPS) and radiographically in order to assess the positioning of the prosthetic components and signs of loosening. Statistical analyses investigated the presence of clinical and radiographic variables as predictive factors of poor functional outcomes. RESULTS Similar MEPSs were observed in the affected and unaffected ar...
“A Study of Surgical Management of Intra Articular Fractures of Distal Humerus in Adults”
IOSR Journals , 2019
AIM: The aim of the study was to evaluate the functional results of surgical management of distal humerus fractures in adults involving the articular surface. PATIENTS AND METHODS: This is a prospective study of 30 cases of distal humerus fractures in adults involving the articular surface who are admitted to Guntur government hospital between November 2012 and September 2014.Cases were taken according to inclusion and exclusion criteria. RESULTS: In our study 30 cases were treated.25 were males and 5 patients were females.The mean age was 35 years.63.33% of the fractures were road traffic accidents and 36.67% were due to trivial fall with right side being more commonly affected.Riseborough and Radin Type 3 fractures accounted for 53.33% of cases and type 4 accounted for 46.67%. Out of 30 cases Excellent to Good results were seen in 80% of cases in our study according to Mayo Elbow score. CONCLUSION: From our study we conclude that for a successful internal fixation of distal humerus fractures,it is necessary to maintain anatomic and stable reconstruction of the articular surface and of both humeral columns using two parallel or 90-90° plates.
External fixation for proximal humerus fractures in elderly patients
Orthopedics and rheumatology, 2021
Background: Proximal humeral fractures account for 4-6% of all fractures and 25% of humeral fractures. Proximal humerus fractures are very common and often accompanied by osteoporosis in elderly population. The external fixation is one of the surgical options to treat proximal humeral fractures. The aim of this study is to evaluate the clinical and radiological results of osteosynthesis by close reduction and external fixation in the management of displaced proximal humerus fractures in elderly population. Material and Methods: From Jan 2012 through December 2015, five elderly adult patients (≥60 years) with displaced proximal humeral fracture were treated by close reduction and external fixation using the FERN ™external fixation frame. Radiograph was used to evaluate bony union, wires migration, and fragment displacement. Clinical outcomes were evaluated the 1-10 visual analog score (VAS), and the American Shoulder and Elbow Surgeons Shoulder Score (ASES). Results: Regarding the clinical outcomes at the final follow up, the means of the visual analogue scale (VAS), and the American Shoulder and Elbow Surgeons Shoulder Score (ASES) of the injured shoulders were 0.8 (range, 0-2), and 90.6 (range, 81-97) respectively. Radiographic bony union were noted, and external fixators were removed at 47,3± 2,9 days (range 40-63). Nonunion, implant failure, or avascular necrosis of the humeral head were observed during the follow-up. Conclusion: Osteosynthesis with external fixator can be considered today as a valid treatment for proximal humeral fractures in elderly patients. The results in terms of functional recovery are encouraging with a reduced risk of complications.
Total elbow anthroplasty and distal humerus elbow fractures
Hand Clinics, 2004
The indications for total elbow arthroplasty (TEA) have expanded over the last few decades. The initial primary indication for TEA was inflammatory arthritis of the elbow; however, more recently there have been reports on the successful use of TEA for other clinical situations, such as post-traumatic or primary osteoarthritis, nonunion or malunion of the distal humerus, and comminuted distal humerus fractures in elderly patients. As the indications for TEA have expanded, unfortunately the incidence of complications and implant failure also has increased. In 1994 Kraay et al reported their cumulative survival of TEA for post-traumatic arthritis, fractures, or supracondylar nonunion at 3 and 5 years compared with a second group of TEA in patients with inflammatory arthritis. The cumulative survival in the first group was 73% and 53% at 3 and 5 years, respectively, compared with 92% and 90% for the inflammatory group. This has raised concerns for expanding indications of TEA beyond patients with inflammatory arthritis. This article addresses the issues around TEA in the setting of comminuted distal humerus fractures in elderly patients and provides a review of the recent literature on this subject.
Injury, 2014
Total elbow arthroplasty (TEA) is a viable treatment for elderly patients with distal humerus fracture who frequently present with low-grade open fractures. This purpose of this study was to evaluate the results of a protocol of serial irrigations and debridements (I&Ds) followed by primary TEA for the treatment of open intra-articular distal humerus fractures. Seven patients (mean 74 years; range 56-86 years) with open (two Grade I and five Grade 2) distal humerus fractures (OTA 13C) who were treated between 2001 and 2007 with a standard staged protocol that included TEA were studied. Baseline Disabilities of the Arm, Shoulder and Hand (DASH) scores were obtained during the initial hospitalization, and the 6- and 12-month follow-up visits. Elbow range of motion (ROM) measurements were obtained at each follow-up visit. Follow-up averaged 43 (range 4-138) months. There were no wound complications and no deep infections. Complications included one case of heterotopic ossification with...