Functional outcome of elbow joint in AO type 13C fractures treated with open reduction and internal fixation using dual plates


  • Uyyalawada Sreedhar Reddy Department of Orthopaedics, Viswabharathi Medical College, Penchikalapadu village, Kurnool, Andhra Pradesh, India
  • Bheemsingh Samorekar Department of Orthopaedics, Gadag Institute of Medical Sciences, Gadag, Karnataka, India
  • Vinay J. Mathew Department of Orthopaedics, Josco Hospital, Pandalam, Alleppey, Kerala, India
  • Anil Kumar Mettu Department of Orthopaedics, ESIC Medical College, Hyderabad, Telangana, India



Humerus, Distal, Fracture, Open reduction


Background: Distal end of the humerus, with its unique orientation of articular surfaces supported by a meagre amount of cancellous bone, makes its fracture a constant challenge to orthopaedic surgeons. Aim of the study is to evaluate the functional outcome of surgical management of intercondylar AO type C fractures of distal end of humerus using dual plating.

Methods: A prospective study was conducted at our hospital between January 2015 to December 2016. Thirty five consecutive patients with intercondylar (AO Type C) fracture of distal humerus, included in study as per inclusion criteria. All patients were treated surgically using triceps reflecting approach and posterior trans-olecranon approach with ulnar nerve exploration and fixation using dual plating and tension band wiring for olecranon osteotomy wherever done.

Results: In 35 patients, final results using MEPS scoring system excellent outcome is noticed in 15 patients (42.86%), good results is noticed in 13 patients (37.14%), fair result is noticed in 5 patients (14.29%) and poor result is noticed in 2 patients (5.71%). There was statistical significant difference in flexion range of movement arc at 2 and 6 months in our study.

Conclusions: Open reduction and internal fixation of AO type 13C fractures is challenge to surgeon, preoperative planning and mastering the technique over a period of time gives good to excellent functional outcomes.


Author Biographies

Uyyalawada Sreedhar Reddy, Department of Orthopaedics, Viswabharathi Medical College, Penchikalapadu village, Kurnool, Andhra Pradesh, India

Dept. of Orthopaedics

Senior Resident

Bheemsingh Samorekar, Department of Orthopaedics, Gadag Institute of Medical Sciences, Gadag, Karnataka, India

Dept. of Orthopaedics

Assistant Professor

Vinay J. Mathew, Department of Orthopaedics, Josco Hospital, Pandalam, Alleppey, Kerala, India

Consultant Orthopaedics

Anil Kumar Mettu, Department of Orthopaedics, ESIC Medical College, Hyderabad, Telangana, India

Dept. of Orthopaedics

Junior Resident


Korner J, Lill H, Müller LP, Rommens PM, Schneider E, Linke B. The LCP concept in the operative treatment of distal humerus fractures-biological, biomechanical and surgical aspects. Injury. 2003;34(2):20-30.

Jupiter JB, Morrey BF. Fractures of the distal humerus in adults. In: Lampert R. The elbow and its disorder. 3rd ed. Philadelphia, London, New York, St. Louis, Sydney, Toronto: WB Saunders company; 2000: 293-329.

Kuntz JR, David G, Baratz ME. Fractures of the elbow. Orthop Clin North Am Jun. 1999;30(1):37-61.

Robinson CM, Hill RM, Jacobs N, Dall G, Court-Brown CM. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma. 2003;17:38-47.

Lill H, Korner J, Josten C. Fractures of the distal humerus. In: Josten C, Lill H, eds. Elbow Injuries, Biomechanics, Diagnostics, Therapy. Darmstatt: Steinkopff; 2001: 163-182.

McCarty LP, Ring D, Jupiter JB. Management of distal humerus fractures. Am J Orthop. 2005;34:430–8.

Jupiter JB, Neff U, Holzach P. Intercondylar fractures of the humerus: An operative approach. J Bone Joint Surg Am. 1985;67(2):226-38.

Helfet DL, Schmeling GJ. Bicondylar intraarticular fractures of the distal humerus. Clin Orthop Relat Res.1993;292:26-36.

O'Driscoll SW, Sanchez-Sotelo J, Torchia ME. Management of the smashed distal humerus. Orthop Clin North Am. 2002;33(1):19-33.

Holdsworth BJ, Mossad MM. Fractures of the adult distal humerus: Elbow function after internal fixation. J Bone Joint Surg Br 1990;72(3):362-5.

Schmidt-Horlohe K, Bonk A, Wilde P, Becker L, Hoffmann R. Functional results after osteosynthesis of the distal humerus fracture with an anatomically precontoured, angular-stable double plate system. Z Orthop Unfall. 2010;148:300-8.

Tyllianakis M, Panagopoulos A, Papadopoulos AX, Kaisidis A, Zouboulis P. Functional evaluation of comminuted intra-articular fractures of the distal humerus (AO type C). Long term results in twenty-six patients. Acta Orthop Belg. 2004;70(2):123-30.

Chen G, Liao Q, Luo W, Li K, Zhao Y, Zhong D. Triceps sparing versus olecranon osteotomy for ORIF analysis of 67 cases of intercondylar fractures of the distal humerus. Injury. 2011;42(4):366-70.

Wang KC, Shih HN, Hsu KY, Shih CH. Intercondylar fractures of the distal humerus: routine anterior subcutaneous transposition of the ulnar nerve in a posterior operative approach. J Trauma. 1994;36(6):770-3.

Henley MB. Intra-articular distal humeral fractures in adults. Orthop Clin North Am. 1987;18(1):11-23.

Morrey BF, An KN. Functional evaluation of the elbow. In: Morrey BF, editor. The Elbow and its Disorders. 3rd ed. Philadelphia: WB Saunders; 2000: 74-83.

Helfet DL, Hotchkiss RN. Internal fixation of the distal humerus: a biomechanical comparison of methods. J Orthop Trauma. 1990;4:260-4.

Lee SK, Kim KJ, Park KH, Choy WS. A comparison between orthogonal and parallel plating methods for distal humerus fractures: a prospective randomized trial. Eur J Orthop Surg Traumatol. 2014;24(7):1123-31.

Cassebaum WH. Open reduction of T- and Y-fractures of the lower end of the humerus. J Trauma. 1969;9:915-25.

Fernandez-Valencia JA, Munaz-Mahamud E, Ballesteros JR, Prat S. Treatment of AO Type C Fractures of the Distal Part of the Humerus through the Bryan-Morrey Triceps-Sparing Approach. ISRN Orthop. 2013: 525326.

Krishnamurthy MO, Sreenivasulu PSB, Rajkumar K, Mahaboob VS. Evaluation and Outcome of Surgical Management of Supracondylar Fracture Humerus with Intercondylar Extension in Adults. Sch J App Med Sci. 2014;2(6):3274-80.

Sanchez-Sotelo J, Torchia ME, O’Driscoll SW. Complex distal humeral fractures: internal fixation with a principle-based parallel-plate technique. J Bone Joint Surg Am. 2007;89:961-9.

Reising K, Hauschild O, Strohm PC, Sudkamp NP. Stabilisation of articular fractures of the distal humerus: Early experience with a novel perpendicular plate system. Int J Care Injured. 2009;40:611–7.

Athwal GS, Hoxie SC, Rispoli DM, Steinmann SP. Precontoured parallel plate fixation of AO/OTA type C distal humerus fractures. J Orthop Trauma. 2009;23:575-80.

Dasheng T, Juehua J, Jun Q, Jianming L. Comparison of two different double-plate fixation methods with olecranon osteotomy for intercondylar fractures of the distal humeri of young adults. Exp Ther Med. 2013;6:147-51.






Original Research Articles