Double column fixation for type C fractures of the distal humerus by precontoured bi-condylar plating in a 90-90 pattern

Mohammad Rafiqul Islam Khan; Atif Laila; Md. Harun Are Rashid; Muhammad Sayeed Mahmud; Mohammad Shamsul Alam

doi:10.18203/2320-6012.ijrms20251284

Authors

Mohammad Rafiqul Islam Khan Department of Arthroplasty, Dhaka Medical College Hospital, Dhaka, Bangladesh
Atif Laila Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh
Md. Harun Are Rashid Department of Arthroscopy and Sports Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh
Muhammad Sayeed Mahmud Department of Orthopaedic Oncology and Musculoskeletal Tumor, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
Mohammad Shamsul Alam Department of Orthopaedic Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20251284

Keywords:

Distal humerus, Type C fracture, Double column fixation, Bi-condylar plating

Abstract

Introduction: Distal humerus fractures, particularly Type C fractures, present significant challenges in orthopaedic trauma management due to their complexity and the intricacies involved in surgical repair. This study aimed to assess double-column fixation for type C fractures of the distal humerus by pre-contoured bi-condylar plating in a 90-90 pattern.

Methods: This retrospective study was conducted in the Department of Orthopedics, Upazilla Health Complex, Munshigonj, Bangladesh, from January 2014 to January 2018. A total of 38 patients were evaluated based on set criteria. Functional outcomes were assessed using the Mayo Elbow Performance Score (MEPS) at six months. Data were analyzed using SPSS version 20.0, with descriptive statistics applied to demographics, surgical methods, and outcomes.

Result: This study of 38 patients with Type C distal humerus fractures found most were aged ≤47 (71.1%) and male (55.7%). C2 fractures were most common (65.8%). Time to surgery and hospital stay increased with fracture complexity. MEPS results showed 26.7% had excellent and 57.8% good outcomes. Complications included elbow stiffness (21.1%), arthritis (13.2%), heterotopic bone (10.5%), fixation failure (7.9%), and infection (5.3%).

Conclusion: Most patients had good to excellent outcomes based on MEPS. Though some experienced complications like stiffness and heterotopic ossification, overall results support the technique's effectiveness in restoring elbow function.

Metrics

Metrics Loading ...

References

O'Driscoll SW, Jupiter JB, Cohen MS, Ring D, McKee MD. Difficult elbow fractures: pearls and pitfalls. Instructional Course Lect. 2003;52:113-34.

Robinson CM, Hill RM, Jacobs N, Dall G. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. Journal of Orthopedic Trauma. 2003;17(1):38-47. DOI: https://doi.org/10.1097/00005131-200301000-00006

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;34:20-30. DOI: https://doi.org/10.1016/j.injury.2003.09.022

Doornberg JN, Van Duijn PJ, Linzel D, Ring DC, Zurakowski D, Marti RK, Kloen P. Surgical treatment of intra-articular fractures of the distal part of the humerus: functional outcome after twelve to thirty years. JBJS. 2007;89(7):1524-32. DOI: https://doi.org/10.2106/JBJS.F.00369

Bartolotta RJ, Daniels SP, Verret CI, Fufa DT. Current fixation options for elbow, forearm, wrist, and hand fractures. InSeminars in Musculoskeletal Radiology 2019;23(2):109-25). DOI: https://doi.org/10.1055/s-0039-1677699

Schildhauer TA, Nork SE, Mills WJ, Henley MB. Extensor mechanism-sparing participial posterior approach to the distal humerus. J Orthop Trauma. 2003;17(5):374-8. DOI: https://doi.org/10.1097/00005131-200305000-00009

Athwal GS, Hupel TM, Harmer L, Johnstone C, Hall JA, King GJ. Precontoured parallel plate fixation of AO type C distal humerus fractures. J Orthop Trauma. 2009;6:89-91. DOI: https://doi.org/10.1097/BOT.0b013e3181aa5402

Zlotolow DA, Catalano III LW, Barron AO, Glickel SZ. Surgical exposures of the humerus. J American Acad Orthop Surg. 2006;14(13):754-65. DOI: https://doi.org/10.5435/00124635-200612000-00007

McKee MD, Veillette CJ, Hall JA, Schemitsch EH, Wild LM, McCormack R, et al. A multicentre, prospective, randomized, controlled trial of open reduction-internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients. J Should and Elbow Surg. 2009;18(1):3-12. DOI: https://doi.org/10.1016/j.jse.2008.06.005

Sanchez-Sotelo J. Distal humeral fractures: role of internal fixation and elbow arthroplasty. JBJS. 2012;94(6):555-68. DOI: https://doi.org/10.2106/JBJS.946icl

Lauder A, Richard MJ. Management of distal humerus fractures. European J Orthop Surg Traumatol. 2020;30(5):745-62. DOI: https://doi.org/10.1007/s00590-020-02626-1

Wardell W, Auerbach B, Woo MJ, Phykitt D. Common orthopaedic shoulder diagnoses encountered in the primary care setting. Osteopathic Fam Phys. 2023;15(2):24-30. DOI: https://doi.org/10.33181/13097

Ruedi TP, Murphy WM. AO principles of fracture management. InAO principles of fracture management 2000: 868.

Huang JI, Paczas M, Hoyen HA, Vallier HA. Functional outcome after open reduction internal fixation of intra-articular fractures of the distal humerus in the elderly. J Orthop T. 2011;25(5):259-65. DOI: https://doi.org/10.1097/BOT.0b013e3181dfd348

Foruria AM, Lawrence TM, Augustin S, Morrey BF, Sanchez-Sotelo J. Heterotopic ossification after surgery for distal humeral fractures. Bone & Joint J. 2014;96(12):1681-7. DOI: https://doi.org/10.1302/0301-620X.96B12.34091