Functional outcome of locking anatomical plate in extra articular fractures of the distal humerus
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20191781Keywords:
Extra articular, Distal, Humerus, Plate, LCPAbstract
Background: Extra articular distal humerus fractures are difficult to treat with conventional implants like intra medullary nail, 4.5 DCP and dual plate. The present study aims to study the functional outcome of the extra articular distal humerus plate (EADHP).
Methods: 48 patients with displaced extra articular distal humerus fractures were included in the study. Inclusion criteria were age more than 18 years, closed fractures with or without radial nerve palsy and less than 3 weeks old trauma. Patients aged less than 18 years, those having open fractures, fractures more than 3 weeks old, non – unions and pathological fractures were excluded from the study. All patients were operated with EADHP. Clinically, the outcome was assessed by the disability of arm, shoulder and hand (DASH) score and elbow range of motion radiologically, union was evaluated on anteroposterior and lateral radiographs.
Results: Out of 48 patients, 12 had AO type 12 A1 fracture, 26 patients had type B1 fractures and remaining 10 had type C1 fractures. Mean DASH score at final follow up was 18.1; range being 12.6 to 35.7 points. The mean elbow range of motion was 0 to 130 degrees (range: 120 to 140 degrees). The mean duration for complete radiological fracture union was 14 weeks, range being 12 to 18 weeks.
Conclusions: The extraarticular distal humerus plate is an ideal implant for the fixation of distal humerus fractures since it provides good stability of fracture and enables early return to function.
Metrics
References
Sarmiento A, Horowitch A, Aboulafia A, Vangsness CT Jr. Functional bracing for comminuted extra-articular fractures of the distal third of the humerus. J Bone Joint Surg Br. 1990;72(2):283-7
Ali E, Griffiths D, Obi N, Tytherleigh-Strong G, Van Rensburg L. Nonoperative treatment of humeral shaft fractures revisited. J Shoulder Elbow Surg. 2015;24:210-4.
Jawa A, McCarty P, Doornberg J, Harris M, Ring D. Extra-articular distal-third diaphyseal fractures of the humerus. A comparison of functional bracing and plate fixation. J Bone Joint Surg Am. 2006;88:2343-7.
Korner J, Lill H, Müller LP, Hessmann M, Kopf K, Goldhahn J, et al. Distal humerus fractures in elderly patients: Results after open reduction and internal fixation. Osteoporos Int. 2005;16(2):73-9.
Scolaro JA, Voleti P, Makani A, Namdari S, Mirza A, Mehta S. Surgical fixation of extra-articular distal humerus fractures with a posterolateral plate through a triceps-reflecting technique. J Shoulder Elbow Surg. 2014;23:251-7.
Capo JT, Debkowska MP, Liporace F, Beutel BG, Melamed E. Outcomes of distal humerus diaphyseal injuries fixed with a single-column anatomic plate. Int Orthop. 2014;38:1037-43.
Fawi H, Lewis J, Rao P, Parfitt D, Mohanty K, Ghandour A. Distal third humeri fractures treated using the Synthes™ 3.5-mm extra-articular distal humeral locking compression plate: Clinical, radiographic and patient outcome scores. Shoulder Elbow. 2015;7:104-9
Scolaro JA, Matzon JL, Mehta S. Tips and techniques-surgical fixation of extra-articular distal humerus fractures with a posterolateral locking compression plate. Univ PA Orthop J. 2009;19:103-8.
Scolaro JA, Hsu JE, Svach DJ, Mehta S. Plate selection for fixation of extra-articular distal humerus fractures: A biomechanical comparison of three different implants. Injury. 2014;45:2040-4.
Papasoulis E, Drosos GI, Ververidis AN, Verettas DA. Functional bracing of humeral shaft fractures. A review of clinical studies. Injury 2010;41:e21-7.
12. Gosler MW, Testroote M, Morrenhof JW, Janzing HM. Surgical versus non-surgical interventions for treating humeral shaft fractures in adults. Cochrane Database Syst Rev. 2012;1:CD008832.
Schatzker J, Tile M. The Rationale of Operative Fracture Care. 2nd Ed. Toronto: Springer; 1996: 83-94.
Moran MC. Modified lateral approach to the distal humerus for internal fixation. Clin Orthop Relat Res. 1997;(340):190-7.
Levy JC, Kalandiak SP, Hutson JJ, Zych G. An alternative method of osteosynthesis for distal humeral shaft fractures. J Orthop Trauma. 2005;19(1):43-7.
Sharaby M, Elhawary A. A simple technique for double plating of extraarticular distal humeral shaft fractures. Acta Orthop Belg. 2012;78:708-13.
Prasarn ML, Ahn J, Paul O, Morris EM, Kalandiak SP, Helfet DL, et al. Dual plating for fractures of the distal third of the humeral shaft. J Orthop Trauma. 2011;25:57-63.
Yang Q, Wang F, Wang Q, Gao W, Huang J, Wu X, et al. Surgical treatment of adult extra-articular distal humeral diaphyseal fractures using an oblique metaphyseal locking compression plate via a posterior approach. Med Princ Pract 2012;21:40-5.
Spitzer AB, Davidovitch RI, Egol KA. Use of a “hybrid” locking plate for complex metaphyseal fractures and nonunions about the humerus. Injury. 2009;40:240-4.
Saragaglia D, Rouchy RC, Mercier N. Fractures of the distal humerus operated on using the Lambda® plate: Report of 75 cases at 9.5 years followup. Orthop Traumatol Surg Res. 2013;99:707-12.
Jain D, Goyal GS, Garg R, Mahindra P, Yamin M, Selhi HS. Outcome of anatomic locking plate in extraarticular distal humeral shaft fractures. Indian J Orthop. 2017;51:86-92.
Kharbanda Y, Tanwar Y, Srivastava V, Birla V, Rajput A, Pandit R. Retrospective analysis of extra-articular distal humerus shaft fractures treated with the use of pre-contoured lateral column metaphyseal LCP by triceps-sparing posterolateral approach Strat Traum Limb Recon. 2017;12:1–9.
Zimmerman MC, Waite AM, et al. A biomechanical analysis of four humeral fracture fixation systems. J Orthop Trauma. 1994;8(3):233-9.