Paratricepital approach for fixation of distal humerus fracture in adults - A good alternative (original) (raw)
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Paratricepital Approach for Fixation of Distal Humerus Fractures in Adult
Global journal for research analysis, 2017
BACKGROUND: Distal humerus fractures most commonly managed by surgical approaches that disrupt the extensor mechanism of elbow. Paratricepital approach for distal humerus fracture xation has been done by orthogonal or parallel plate construct that allows excellent healing of fracture, motion arc of elbow more than 100 degree, and maintains of extensor mechanism strength. Material and Methods: 30 cases of distal humerus fractures are xed by paratricepital posterior approach. Bicolumner xation done by elevating and retracting the triceps of the distal humerus keeping triceps insertion undisturbed by orthogonal or parallel plate construct. Early active-assisted range of motion initiated within limits of pain. Age group was 15 to 60 years. Among them 21% was type A fracture, 17% type B fracture, 33% type C1 fracture and 29% type C2 fracture. More than 60% of cases have 1 year of follow up. Radiograph and functional evaluation was done by MEPS (Mayo Elbow Performance Score), DASH (Dis...
Indian journal of orthopaedics
Displaced intraarticular distal humerus fracture has been conventionally treated operatively with various triceps disrupting approaches. These approaches are associated with several complications, such as triceps weakness, nonunion or delayed union of osteotomy, implant prominence, and delayed mobilization of the elbow. We present the functional outcome of intraarticular distal humerus fracture fixation using a triceps-sparing paratricipital approach which allows early elbow mobilization and preserving triceps strength. Twenty five patients with intraarticular distal humerus fracture were operated using triceps-sparing paratricipital approach with orthogonal plate construct. There were 16 male and 9 female patients and average age was 42.16 years (range 23-65 years). The mechanism of injury was fall from height (n = 8), road traffic accident (n = 13) and ground level fall (n = 4). Clinical, radiological, and functional assessment with Mayo Elbow Performance Index (MEPI) were obtaine...
" Management of Distal Humerus Fractures
Back ground: The management of distal humerus fractures has been improved over the last few years due to more common use of advanced imaging modalities such as computed tomography (CT), understanding the benefits of parallel-plating techniques, the recognition of the more complex patterns of shear fractures of the articular surface of the distal humerus, the widespread use of precontoured periarticular plates, and the selective use of elbow arthroplasty. Methodology: this study was done in Government General HospitalSiddhartha Medical College Vijayawada. It is a prospective study.done from December 2015 to June 2017,in 20 members of patients. All surgeries were performed by single orthopaedic surgeon at Government General Hospital / Siddhartha Medical college. The type of fracture, time delay for surgery, surgical approach, complications and outcome were recorded. based on inclusion and exclusion criteria. Results: In the present study of 20 cases the average age was 35 years. The youngest age was 21 years and oldest age was 55 years. The Male/ Female ratio was 1.85:1. In present study 12 cases sustained dominant hand injuries. Fractures sustained in a road traffic accident(most common) were more comminuted. Shin SJ et al 1 compared clinical outcomes in patients with intraarticular distal humerus fractures using 2 different double plating methods. 17 patients were treated by orthogonal plating and 18 patients were treated by parallel plating. Arc of flexion, bone union was better in parallel plating compared to orthogonal plating. 2 Patients were follow-up for an average of 8months (range 3 months to 15 months). Excellent results were found in 8cases (40%); Good results in 7 cases (35%), sum of excellent to good results of 15 cases (75%) and fair results were obtained in 5(25%) cases. In present study the functional Flexion-Extension arc gained was at an average of 100 0. No post operative permanent nerve palsies were found except transient ulnar nerve palsy in one case, which was managed conservatively which recovered completely.In this study hardware pain was noticed in 2 patients. In them proud k-wires were removed after union. We had one case of deep Infection for which we did a thorough lavage and treated the patient with high end antibiotics. The patient recovered the fracture united but the patient had elbow stiffness with functional range of motion. Conclusion:1 In the surgical management of fractures of the distal humerus anatomical reduction of the articular surface, rigid and stable internal fixation of the distal humerus medial and lateral pillars and accurate reconstruction of the trochlea and capitellum are of prime importance in achieving an excellent functional outcome.2.For open reduction and internal fixation of fractures of the distal humerus, we got similar results with Triceps Reflecting Anconeus Pedicle, Triceps-splitting and Olecranon Osteotomy approach Parallel plating of medial and lateral pillars is the preferred technique by us to have a stable and rigid anatomical construct allowing early mobilization.
Distal Humeral Fractures-Current Concepts
The open orthopaedics journal, 2017
Distal humerus fractures constitute 2% of all fractures in the adult population. Although historically, these injuries have been treated non-operatively, advances in implant design and surgical technique have led to improved outcomes following operative fixation. A literature search was performed and the authors' personal experiences are reported. This review has discussed the anatomy, classifications, treatment options and surgical techniques in relation to the management of distal humeral fractures. In addition, we have discussed controversial areas including the choice of surgical approach, plate orientation, transposition of the ulnar nerve and the role of elbow arthroplasty. Distal humeral fractures are complex injuries that require a careful planned approach, when considering surgical fixation, to restore anatomy and achieve good functional outcomes.
Challenges and Solutions in Management of Distal Humerus Fractures
The open orthopaedics journal, 2017
Management of distal humerus fractures remains a challenge for trauma surgeons and advancements in treatment options continue to be made to achieve the best results for patients presenting with these complex fractures. Our aim in this article is to provide the surgeons with a detailed review of current literature to help them make an evidence based decision when faced with managing such complex injuries in their surgical practice. This is a comprehensive review of the current literature that details various aspects of distal distal humerus fractures such as classification, surgical anatomy, surgical approaches, treatment options, choices of devices, outcomes and complications. With the advancements in techniques and equipment, there has been improvement in patients' outcomes following surgical management of these fractures and a large proportion of these patients are able to achieve pre-injury level of function. The contoured locking plates have enabled successful fixation of ma...
Management of Fractures of Distal End of Humerus by Triceps- Sparing Approach
IOSR Journals , 2019
Background: Displaced intraarticular distal humerus fracture has been conventionally treated operatively with various triceps disrupting approaches. These approaches are associated with several complications, such as triceps weakness, nonunion or delayed union of osteotomy, implant prominence, and delayed mobilization of the elbow. We present the functional outcome of intraarticular distal humerus fracture fixation using a triceps-sparing approach which allows early elbow mobilization and preserving triceps strength. Materials and Methods: Twenty patients with intraarticular distal humerus fracture were operated using triceps-sparing approach with orthogonal plate construct. There were 14 male and 6 female patients and average age was 35.05 years (range 18-62 years). The mechanism of injury was fall from height (n = 3), road traffic accident (n = 12) and ground level fall (n = 5). Clinical, radiological, and functional assessment with Mayo Elbow Performance Index (MEPI) were obtained at follow up period. Results: All fractures united primarily. At the mean follow up of 8.7 months (range 6-16 months), mean elbow flexion was 134.55° (range 121°-142°) and mean motion arc was 129.1°(range 106°-140°). The mean MEPI score was 95.75 points (range 80-100) with 18 excellent, and 2 good results. The mean flexion deformity or extension loss was 5.45° (range 5°-15°). Conclusion: Open reduction and internal fixation of intraarticular distal humerus fractures with triceps-sparingapproach provide adequate exposure with no adverse effect on triceps muscle strength and allows early initiation of elbow motion. We analyzed, age and injury to surgical interval with relation to functional range of elbow using Z-test which is insignificant.
Introduction The optimal treatment of humeral shaft fractures continues to be debated. In the current investigation, we sought to determine the clinical and radiographic outcomes following the plate fixation of humeral shaft fractures utilizing the modified posterior approach. Materials and methods A retrospective review identified a consecutive series of 30 humeral shaft fractures (OTA20-A, 10-B, or 0-C) treated with plate fixation via a posterior (14 patients), ormodified posterior approach (16 patients) between 2016 and 2017 by a single surgeon. Demographics, operative reports, clinical follow-up, and preoperative radiographs were reviewed. Postoperative radiographs were assessed for angular deformity and time to union. Range of motion and strength testing were also reviewed. Results A total of 30 humeral shaft fractures were reviewed with a mean clinical follow-up of 4 months. The mean time to union was13.1 weeks and there3 patients developed radial nerve palsies in posterior approach group and one case in modified posterior approach postoperatively. Conclusionboth approaches could be used in the management of humeral diaphyseal middle or distal third fractures, And the modified posterior approach confirmed by our results minimizes the complication rate, allow early return of full range of elbow motion and full triceps muscle power and facilitates early return to normal activities of the patient with excellent functional out comes .
A study of different surgical modalities in the management of proximal humerus fractures
International Journal of Orthopaedics Sciences
Background: Proximal humerus fractures are common but debilitating injuries. Numerous factors contribute to post injury functional outcomes; therefore, a large debate exists over appropriate treatment. Optimal treatment for displaced or unstable two, three, and four-part proximal humerus fractures remains controversial. This study is conducted to analyze the results of proximal humerus fractures treated by different modalities of surgical fixation. Materials & Methods: This study was carried out in Malla Reddy Institute of Medical Sciences, from July 2016 to June 2018. Thirty patients of displaced proximal humeral fractures were admitted in this hospital and treated surgically by PHILOS plate, K-wire and hemiarthroplasty. Follow up is done from 4 weeks to 12 months both clinically and radiologically. Results were evaluated by the use of Neer's shoulder score. Results: Most common mode of injury was found to be road traffic accident and the most common type was two part fracture accounting for 12 out of 30 patients (40%).The results were evaluated by Neer's score. The average follow up duration was 11.4 months. Of the thirty patients, 7 (23.3%) had excellent results, 17 (56.7%) had satisfactory results, 4 (13.3%) had unsatisfactory results and 2 (6.67%) were failure. Conclusions: Closed reduction and percutaneous pinning can be used for un-displaced or displaced fractures of the proximal humerus without comminution, in the younger age groups with good bone quality. In older individuals it is good to fix with percutaneous K wires, considering bone density (osteoporosis) and also to reduce the period of surgery. K wire fixation gave excellent results in our patients for the treatment of unstable 2 part proximal humerus fractures. Proximal humerus locking plate (PHILOS) gives reliable fixation for 2-part and 3-part fractures and has good functional outcome. In more complicated fracture patterns of 4-part fractures, its use is associated with poor clinical outcome. Prosthetic replacement should be considered as primary treatment in cases with marked comminution of the humeral head, in fracture-dislocations, and in elderly patients.
Functional outcome evaluation of distal humerus fracture fixation
Fracture fixations by K wires and distal one third semi tubular plate have resulted in a high percentage of implant failures, in presence of metaphyseal communition. In osteoporotic bone and in very distal fractures, screw placement becomes difficult because of limited space ABSTRACT Background: Distal humerus fracture are complex, difficult to reduce and fix, cumbersome post-operative mobilization, and yet functional outcome is doubtful. Though various treatment modalities available for past many decades ranging from conservative management, K wire fixation to plate and screws, but still treatment remains difficult. The objective of the study was to assess functional outcome of operative fixation of distal humerus with locking plate and screws. Methods: Prospective study was done in during November 2015 to June 2016 in Vydehi Institute of Medical Sciences and Research Centre, Bengaluru. Patients with distal humerus fractures who were admitted into hospital for operative treatment after fulfilling inclusion and exclusion criteria were included into study. They were followed up to 6 months post-operatively. Functional outcome evaluation was done with Mayo's elbow performance score. Results: 30 patients were included into study with full data. We had excellent, good, fair and poor outcome in 17, 8, 3, 2 patients respectively. Except for infection in one, elbow stiffness in two and non-union in two patients, we had no other complications. Conclusions: Management of distal humerus fractures with preoperative evaluation, pre-operative planning, use of locking plate and screws, early mobilization can result in good functional outcome.