Elsevier

Injury

Volume 35, Issue 1, January 2004, Pages 44-54
Injury

Surgical fixation of intra-articular fractures of the distal humerus in adults

https://doi.org/10.1016/S0020-1383(02)00332-7Get rights and content

Abstract

We reviewed 15 adult patients with intra-articular fractures of the distal humerus treated over a period of 2 years. All patients underwent primary open reduction and internal fixation, which included 11 double plating procedures. The fractures were classified according to the AO/ASIF system. Patient outcome was assessed subjectively by scoring the patients’ residual symptom of pain and their overall satisfaction of the treatment received. Objective assessment was performed using the Mayo Elbow Performance Index (range of motion, assessment of functional status, pain and stability of the joint). At a mean follow-up of 12.3 months, 7 patients were rated as excellent; 6, as good; one, as fair; and one, as poor. These cases had an average arc of flexion of 109.7°. The sub-group of type C fractures without revision surgery had a mean flexion arc of 110.7° (95–140°), with 100% Good to Excellent scores. Complications included two post-operative ulnar nerve neuropraxia, one wound infection, and one fracture fibrous non-union. Three patients required revision surgery which included a total elbow arthroplasty for implant failure, whilst four patients (including the patient with the subsequent arthroplasty) required joint mobilisation procedures for residual stiffness.

Introduction

Intra-articular fractures of the distal humerus are not common and remain one of the most difficult fractures to treat. Non-operative treatment traditionally results in dismal functional outcome with disabling limitations of elbow motion. However, over the past two decades, operative reduction and internal fixation has become more accepted as a means to achieve anatomical restoration of the articular surface and facilitate early mobilisation. Nevertheless, many authors differ in their opinions with regard to the extent and type of internal fixation, as well as the duration of post-operative immobilisation. The improved AO/ASIF techniques for the fixation of small articular fragments has made operative results more predictable and more recently, dual plate fixation in two planes has become the standard of treatment.1., 2. Based on the AO/ASIF classification of this fracture, we retrospectively reviewed our results for 15 patients operated over a period of 2 years.

Section snippets

Material and methods

We treated 15 adult patients with intra-articular distal humerus fractures between 1998 and 2000. All the fractures were classified using the AO/ASIF classification. Twelve patients had complete articular grade C fractures (4 type C1; 4 type C2; and 4 type C3 fractures), and the remaining 3 patients each had a type B1, B2, and B3 partial articular fracture. All patients were identified from the hospital computer database and a review of their medical notes was performed.

The mean age of our

Results

We report the overall results of all 15 patients with the AO/ASIF types B, partial articular; and C, complete articular fractures (Table 1).

Complications

In our series of 15 patients, complications included two post-operative ulnar nerve neuropraxia (Table 3), one wound infection (patient 9), and one fracture fibrous non-union (patient 10). All nerve injuries recovered between 2 and 9 months after surgery.

Discussion

Numerous operative approaches have been described for the distal humerus.3 The posterior approach was used in all our patients. Amongst these, the “triceps-lift” was used in six patients, five of whom have type C fractures. Alonso-Llames in 1972 described this triceps preserving “bilaterotricipital” approach to the elbow.4 The distal humerus is approached from the medial and lateral sides of the long head of triceps (i.e. between the medial and long heads, and between the long and lateral heads

Conclusions

We reviewed 15 patients with intra-articular distal humerus fractures treated surgically, of which three required subsequent re-fixation, and four underwent joint mobilisation surgery. The mean arc of flexion of our patients with type C fractures following primary fixation is 92.5° (45–140°), whilst the type B group have a mean arc of 110° (60–145°). The sub-group of type C patients without revision surgery had a mean flexion arc of 110.7° (95–140°), with 100% Good to Excellent scores. Our

References (15)

  • W.H. Cassebaum

    Operative treatment of T and Y fractures of the lower end of the humerus

    Am. J. Surg.

    (1952)
  • D. Ring et al.

    Fractures of the distal humerus

    Orthoped. Clin. North Am.

    (2000)
  • J.B. Jupiter et al.

    Intercondylar fractures of the humerus—an operative approach

    J. Bone Jt. Surg. (American)

    (1985)
  • G.T. Gabel et al.

    Intraarticular fractures of the distal humerus in the adult

    Clin. Orthopaed. Rel. Res.

    (1987)
  • Morrey BF. Surgical exposures of the elbow. In: Morrey BF, editor.The elbow and its disorders. 2nd ed. Philadelphia:...
  • S.D. Patterson et al.

    Surgical approaches to the elbow

    Clin. Orthopaed. Rel. Res.

    (2000)
  • D.L. Helfet et al.

    Internal fixation of the distal humerus: a biomechanical comparison of methods

    J. Orthopaedic Trauma

    (1990)
There are more references available in the full text version of this article.

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    Furthermore, two of the studies included by Ljungquist et al [12] were excluded in our review; this was because of our strict inclusion criteria. Of these, one study by Soon et al [37] was excluded as it included extra-articular fractures, in addition to intra-articular fractures. The other study by Athwal et al [38] was excluded as it primarily evaluated the results of a parallel plating system rather than the choice of surgical approach.

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    Finally, the study design is retrospective and therefore more susceptible to data loss, bias, and confounding than a prospective study. Our incidence of reoperation for loosening or breakage of implants and nonunion after operative treatment of type C distal humerus fractures (12%) is consistent with prior studies (mean, 11%; range, 2% to 21%).3–8 There is some rationale to support the factors associated with reoperation for loosening or breakage of fixation or nonunion in our study.

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