Promising results after the treatment of simple and complex distal humerus type C fractures by angular-stable double-plate osteosynthesis - 02/09/13
, A. Bonk b, P. Wilde a, L. Becker a, R. Hoffmann a
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Summary |
Introduction |
The aim of this study was to evaluate the functional results and complications following open reduction and internal fixation of distal humerus type C fractures (AO classification) using an anatomically precontoured, angular-stable double-plate system.
Patients and methods |
The study is a retrospective analysis of 45 patients with 46 type C fractures. There was one C1, eight C2 and 31 C3 fractures. Twelve fractures were open (Gustilo classification). Follow-up was performed on 38 patients with 39 fractures (84%) after 14 months (range, 12–22). The mean age was 50 years (range, 14–87). Functional results were evaluated using the Mayo Elbow Performance Score (MEPS); the Disabilities of the Arm, Shoulder and Hand score (DASH); and range-of motion (ROM) measurements. Complications were classified as minor or major, and the postoperative and follow-up X-rays were analyzed.
Results |
Thirty-four fractures were considered stable to allow early physical therapy. With a mean MEPS of 85 points, 36 results (36/39 [92%]) were rated as excellent or good. The mean DASH was 22.5 points, and the ROM for extension-flexion was 105° (range, 50–145). Sixteen major complications (eventually coexistent: 6×implant failure, 3×non-union, 6×stiffness, 2×necrosis capitulum, 4×failure olecranon osteotomy refixation) and two minor complications were recorded in 17 patients. These adverse events led to 14 revision surgeries (14/39 [36%]). Except for extension deficit, no statistically significant differences were found between the articular simple and articular complex fractures and when comparing the results between patients with and without a major complication.
Conclusion |
The anatomically precontoured and angular-stable double-plate system provides sufficient immediate postoperative stability to allow early physiotherapy, even in C3-type fractures. Excellent or good results could be achieved in the vast majority of patients, independent on having suffered a complication or not. Complication rates were remarkably high, emphasizing the difficulties associated with this rare type of fracture.
Level of evidence |
Level IV Retrospective study.
Le texte complet de cet article est disponible en PDF.Keywords : Distal humerus fracture, Osteosynthesis, Angular-stable fixation, Anatomically shaped, Functional result, Complications, Perpendicular plating
Plan
Vol 99 - N° 5
P. 531-541 - septembre 2013 Retour au numéro
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