Osteosynthesis of Complex Fractures of the Distal Humerus. Our Experience
Abstract
Objective: To describe the results obtained in the treatment of distal humerus fractures by open reduction and internal fixation (ORIF) and to reflect whether the approach used had an impact on the functional outcome. Materials and Methods: We carried out a retrospective case study of 19 patients with a diagnosis of complex distal humerus fracture who were treated with ORIF from 2015 to 2021. Periodic radiographic controls were performed and the functional outcome was evaluated using internationally known scales such as the DASH and Mayo Elbow performance Score (MEPS), then the variables obtained were extrapolated using statisticalsoftware. Results: A 100% consolidation rate was achieved; in 7 patients (37%), the Alonso Llames approach was used and in 12 cases (63%), we performed an olecranon osteotomy. The average DASH was 11.31, which determined mild disabilities. The MEPS obtained was excellent in 1 patient (5.26%), good in 10 (52,6%), fair in 7 (36.84%), and poor in 1(5.26%). When comparing the results obtained through the different approaches a P = 0.4197 was obtained in the ANOVA test and P =0.4723 in the Mann-Whitney/Wilcoxon Two sample Test. Conclusions: We conclude that ORIF is effective in the treatment of complex fractures of the distal humerus, allowing the surgeon to obtain good post-surgical results. In this series, the average DASH was 11.31, with excellent and good results in 57% of the patients. We found no statistically significant difference regarding the choice of one approach or the other.Downloads
References
Xiaohan Wang, Guoyan Liu. A comparison between perpendicular and parallel plating methods for distal humerus fractures. Medicine 2020;99(23):19602. https://doi.org/10.1097/MD.0000000000019602
Galal S, Mattar Y, Solyman AME, Ezzat M. Locking versus non-locking plates in fixation of extra-articular distal
humerus fracture: a randomized controlled study. Int Orthop 2020;44(12):2761-7. https://doi.org/10.1007/s00264-020-04770-z
Ljungquist KL, Beran MC, Awan H. Effects of surgical approach on functional outcomes of open reduction
and internal fixation of intra-articular distal humeral fractures: a systematic review. J Shoulder Elbow Surg
;21(1):126-35. https://doi.org/10.1016/j.jse.2011.06.020
Hudak PL, Amadio PC, Bombardier C, Beaton D, Cole D, Davis A, et al. Development of an upper extremity
outcome measure: The DASH (disabilities of the arm, shoulder, and head). Am J Ind Med 1996;29:602-8.
https://doi.org/10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L
Sanchez-Sotelo J. Distal humerus fractures: Fractures of the columns with articular involvement. En: Morrey BF, Sanchez-Sotelo J, Morrey ME (ed). Morrey’s the elbow and its disorders. 5th ed. Philadelphia: Elsevier; 2018:450-7. https://doi.org/10.1016/B978-0-323-34169-1.00045-0
O’Driscoll SW. Optimizing stability in distal humeral fracture fixation. J Shoulder Elbow Surg 2005;14(1 Suppl
S):186S-194S. https://doi.org/10.1016/j.jse.2004.09.033
Allende BT, Allende BL. Fracturas complejas del extremo distal del húmero. Tratamiento quirúrgico. Rev Asoc Arg Ortop Traumatol 1997;62(1):24-38. Disponible en: http://aaot.org.ar/revista/1993_2002/1997/1997_1/620102.pdf
Liu JJ, Ruan HJ, Wang JG, Fan CY, Zeng BF. Double-column fixation for type C fractures of the distal humerus in
the elderly. J Shoulder Elbow Surg 2009;18(4):646-51. https://doi.org/10.1016/j.jse.2008.12.012
Sanchez-Sotelo J, Torchia ME, O’Driscoll SW. Complex distal humeral fractures: internal fixation with a principlebased parallel-plate technique. Surgical technique. J Bone Joint Surg Am 2008;90 Suppl 2 Pt 1:31-46.
https://doi.org/10.2106/JBJS.G.01502
Sanchez-Sotelo J. Distal humeral fractures: role of internal fixation and elbow arthroplasty. Instr Course Lect 2012; 61:203-13. PMID: 22301233
Shearin JW, Chapman TR, Miller A, Ilyas AM. Ulnar nerve management with distal humerus fracture fixation: A
meta-analysis. Hand Clin 2018;34(1):97-103. https://doi.org/10.1016/j.hcl.2017.09.010
Pollock JW, Faber KJ, Athwal GS. Distal humerus fractures. Orthop Clin North Am 2008;39(2):187-200, vi.
https://doi.org/10.1016/j.ocl.2007.12.002
Lauder A, Richard MJ. Management of distal humerus fractures. Eur J Orthop Surg Traumatol 2020;30(5):745-62. https://doi.org/10.1007/s00590-020-02626-1
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
