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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Type C distal humerus fractures. A 15-year experience in a demanding surgical issue

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  • presenting/speaker Efstratios Athanaselis - Orthopaedic Dpt, University Hospital of Larissa, Larissa, Greece
  • Dimitrios Deligeorgis - Orthopaedic Dpt, University Hospital of Larissa, Larissa, Greece
  • Georgios Komnos - Orthopaedic Dpt, University Hospital of Larissa, Larissa, Greece
  • Ioannis Antoniou - Orthopaedic Dpt, University Hospital of Larissa, Larissa, Greece
  • Sokratis Varitimidis - Orthopaedic Dpt, University Hospital of Larissa, Larissa, Greece
  • Konstantinos Malizos - Orthopaedic Dpt, University Hospital of Larissa, Larissa, Greece

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-376

doi: 10.3205/19ifssh0088, urn:nbn:de:0183-19ifssh00889

Published: February 6, 2020

© 2020 Athanaselis et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: In this retrospective study we evaluated long term outcomes of type C (AO classification) distal humerus fracture treated with open reduction and internal fixation with plates.

Methods: From 2002 to 2016, 32 patients with type C distal humerus fracture were treated operatively by plating. Fifteen were males (47%) and 17 females (53%) with a mean age of 53.5 years (18 to 83). Three fractures were open (9.4%), two patients had an ipsilateral olecranon fracture and one patient olecranon and radial head fracture. Fractures resulted from simple fall in 22 patients, fall from a significant height in 6 and motor vehicle accident in 4.

All patients were treated operatively by posterior approach and olecranon osteotomy using two plates (preferably precontoured LCP plates, parallel placed) often combined with free screws and K-wires. Olecranon was fixed by tension band technique in 26 patients and by other technique (screw, plate) in 6. Elbow mobilization under protection started after 2 weeks postoperatively. Mean follow-up was 8.7 years (2-15.5).

Results and Conclusions: In 29 patients (90.6%) fracture healed after 8 weeks in average (6 to 10). There were 3 non-unions (9.4%), 9 cases of malunion of varied importance (28.1%), 1 deep infection (3.1%), 1 postoperative ulnar neuropathy, and 1 CRPS treated appropriately. Reoperation rate was 18.7% (6 patients). Postoperative ulnar palsy was present in 3 patients (9.4%). Tension band was removed in 7 patients (21.9%).

Carrying angle (average 8o, 5-17o) and posterior angulation (average 45o, 40-56o) of distal humerus were measured. Intercondylar distance was normal in 23 patients (72%). In 9 patients it was 16.7% in average (5-25%) narrower compared with the contralateral.

Average ROM was 117o (range 75-150o), extension lag 21o (0-45o) and elbow flexion 141o (120-150o). Mean DASH score was 20 (0-49) and mean MEPS 83.3 (25-100).

At final follow up half of the patients (16/32) had some kind of osteoarthritic changes and three had heterotopic ossification.

Two-column fixation of type C distal humerus fractures by posterior approach and olecranon osteotomy using plates (preferably pre-contoured LCP) provides satisfactory results. Anatomic reduction and stable fixation are prerequisites for early mobilization, preventing elbow stiffness.