Staged tricortical bone graft with internal fixation in complex distal humerus fracture: a prospective study
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20243901Keywords:
Distal humerus fractures, Tricortical bone graft, Internal fixation, Orthopaedic surgery, Functional recovery, Radiographic unionAbstract
Background: Complex distal humerus fractures present a significant challenge in orthopaedic surgery. This study evaluates the efficacy of staged tricortical bone graft combined with internal fixation in these fractures.
Methods: A prospective study involving 50 patients with complex distal humerus fractures treated with staged tricortical bone graft and internal fixation was conducted. The primary outcomes measured were radiographic union and functional recovery using DASH and MEPS scores over a 12-month period.
Results: Radiographic union was achieved in 100% of patients at 12 months. Significant improvements in functional outcomes were noted, with DASH and MEPS scores improving from 75.3 and 55.4 at baseline to 20.1 and 95.0, respectively, at 12 months (p<0.001). The complication rate included an 8% incidence of postoperative infection and a 6% rate of non-union. Subgroup analysis indicated slightly better outcomes in patients under 50 years.
Conclusion: Staged tricortical bone graft combined with internal fixation demonstrates high efficacy in treating complex distal humerus fractures, offering high union rates and significant functional improvements. While the results are promising, further research is needed for broader validation.
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References
McKee MD, Wilson TL, Winston L, Schemitsch EH, Richards RR. Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach. J Bone Joint Surg Am. 2000;82(12):1701-7.
Palvanen M, Kannus P, Niemi S, Parkkari J. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res. 2006;(442):87-92.
Sanchez-Sotelo J. Distal humeral fractures: role of internal fixation and elbow arthroplasty. Instr Course Lect. 2011;60:191-201.
Korner J, Lill H, Müller LP, Hessmann M, Kopf K, Goldhahn J, Gonschorek O, Josten C. Distal humerus fractures in elderly patients: results after open reduction and internal fixation. Osteoporos Int. 2005;16(2):73-9.
Ring D, Gulotta L, Chin K. Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus. J Orthop Trauma. 2004;18(7):446-9.
Jupiter JB, Goodman LJ. The management of complex distal humerus fractures in the elderly with elbow hemiarthroplasty. Orthop Clin North Am. 2010;41(2):273-82.
Goulet JA, Senunas LE, DeSilva GL, Greenfield ML. Autogenous iliac crest bone graft. Complications and functional assessment. Clin Orthop Relat Res. 1997;(339):76-81.
Morrey BF, An KN. Functional anatomy of the ligaments of the elbow. Clin Orthop Relat Res. 1985;(201):84-90.
Frankle MA, Herscovici D Jr, DiPasquale TG, Vasey MB, Sanders RW. A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraarticular distal humerus fractures in women older than age 65. J Orthop Trauma. 2003;17(7):473-80.
Khan SN, Cammisa FP Jr, Sandhu HS, Diwan AD, Girardi FP, Lane JM. The biology of bone grafting. J Am Acad Orthop Surg. 2005;13(1):77-86.
Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The upper extremity collaborative group (UECG). Am J Ind Med. 1996;29(6):602-8.
Morrey BF, An KN, Chao EY. Functional evaluation of the elbow. In: Morrey BF, editor. The Elbow and Its Disorders. 2nd ed. Philadelphia: WB Saunders; 1993: 86-97.
Athwal GS, Hoxie SC, Rispoli DM, Steinmann SP. Pre-contoured parallel plating technique for treatment of olecranon fractures. J Orthop Trauma. 2008;22(8):575-80.
Ring D, Lawrence BA, Kingsley C, Jesse B. Olecranon Osteotomy for Exposure of Fractures and Nonunions of the Distal Humerus. J Orthopaed Tra. 2004;18(7):446-9.
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(5):961-9.
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.
McCarty, Ring L, David, Jesse J. Management of distal humerus fractures. Am J Orthop. 2005;34:430-8.
Frankle MA, Herscovici D Jr, DiPasquale TG, Vasey MB, Sanders RW. A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraarticular distal humerus fractures in women older than age 65. J Orthop Trauma. 2003;17(7):473-80.
Danny P. Goel, Jeffrey M. Pike, George S. Athwal. Open Reduction and Internal Fixation of Distal Humerus Fractures. Oper Techniq Orthopaed. 2010;20(1):24-33.