Risks of complications in the treatment of humerus distal fractures are rather high.  This gives rise to a lot of controversy and, as a result, the need for research and development aimed at preventing errors and complications. Purpose: to study the structure of errors and complications being arisen in the treatment of patients with distal fractures of the humerus, and outline ways to eliminate them. Material and methods: A retrospective analysis of treatment outcomes was performed in 72 patients (52 men and 20 women, mean age 39.7 years) with distal humerus fractures. During treatment with the use of external osteosynthesis the errors and complications were identified in 43 patients (group I), 29 patients (group II) had error and complications after transosseous osteosynthesis. Results: Analysis of adverse treatment outcomes showed that in group I, diagnostic errors amounted to 2.3%, tactical errors - 11.6%, technical errors - 20.4%. In group II, only technical errors were noted and they accounts for 10.8%. Surgical treatment errors of this localization injuries led to the development of 23.3% of failures with external osteosynthesis, and 13.8% with transosseous osteosynthesis. Conclusions: a surgeon’s qualification is the most important factor in distal humerus fractures patients treatment. This should include experience, application of optimal treatment tactics in each specific case, and anticipation of various complications development.

The results of the first clinical application of the developed external device for osteosynthesis of distal humerus fractures are presented. Purpose: to improve the extrafocal method of reposition and fixation of humerus shaft fractures at the level of the lower third, taking into account the anatomical and physiological features of the area damaged. Material and methods: Functional, basic fixing and repositioning capabilities of the previously used external device, its advantages and disadvantages are considered.  A minimally invasive guided technique for external rod fixation in the treatment of low third humerus’ fractures is described. An improved version of the apparatus layout and transosseous osteosynthesis technology was used in 10 patients. The design of the device allows to eliminate the displacement of the humerus fragments, ensures the stability of their fixation, while maintaining the function of the elbow joint. The indications for the use of external fixation were extra-articular fractures of the humerus in the distal third - type 12A (n = 6), 12B (n =3) and 12C (n =1) according to the AO / ASIF classification. Results: The analysis of treatment outcomes showed that the technology of minimally invasive osteosynthesis allows to achieve positive results in most patients with a minimum of complications - 90.5 ± 3.3 points according to MEPS’s clinic method of assessing the function of the elbow joint. Conclusions: The developed device for transosseous osteosynthesis of distal humerus fractures, is the method of choice and can be widely used in traumatology and orthopedics.

Background. The article deals with extra-articular fractures of the distal humerus, according to the АО/ASIF classification, which includes types 12A–C, depending on the plane of the fracture and the nature of the fragment displacement. The purpose was to study the features of the lower third humeral fractures and to conduct a comparative analysis of the outcomes of surgical treatment. Material and methods. One hundred and twenty-seven patients with extra-articular fractures of the distal humerus were under observation. For retrospective analysis, they were divided into a comparison group (n = 92) who underwent traditional bone osteosynthesis and a study group (n = 35) in whom a rod-type external fixation device developed by us was used. The short- and long-term functional results were studied using the Mayo Elbow Performance Score. Results. Various indicators, established by us for comparison, and treatment outcomes were analyzed in 101 patients (comparison group — 68 people, study group — 33). Many values of these parameters were quite comparable in terms of the age, gender, hospitalization terms, duration of surgeries, etc., but the revealed differences in indicators still did not reach the level of statistical reliability (p > 0.05). Evaluation of the clinical use of the device proposed by us showed restoration of the humeral anatomy, quite comparable to that in bone osteosynthesis, and the achievement of the final result of treatment. However, the number of complications by type and by total number was significantly higher (4.5 times; p ˂ 0.001) in the comparison group, where it accounted for the largest share of cases of neuropathies (16.18 %), nonunions (8.82 %), elbow contractures (8.82 %) and heterotopic ossification (4.42 %). The final score on the Mayo Elbow Performance Score in the comparison group was 84.9 ± 10.2 points, in the study group — 92.6 ± 3.7 points. At the same time, the total number of positive treatment outcomes after bone osteosynthesis was 66.18 %, after transosseous osteosynthesis — 81.82 %. Conclusions. The analysis of the data obtained allows us to recommend a method of minimally invasive osteosynthesis with a rod device of external controlled fixation as a method of choice for wider clinical use in the treatment of patients with lower third humeral fractures.