Complications of open reduction and internal fixation of distal humerus fractures

Savvidou, Olga D.; Zampeli, Frantzeska; Koutsouradis, Panagiotis; Chloros, George D.; Kaspiris, Aggelos; Sourmelis, Savas; Papagelopoulos, Panayiotis J.

doi:10.1302/2058-5241.3.180009

Cited by 41 publications

(31 citation statements)

References 71 publications

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“…Nonunion rates following ORIF of distal humerus fractures are reported to be between 2 and 10%. 18,21 In the present study, there were zero nonunions of the distal humerus, similar to results of more recent published series of simpler fractures. 21 Heterotopic ossification (7-9%) is a significant problem after ORIF of distal humerus fractures, causing stiffness and pain which calls for reoperation.…”

Section: Discussionsupporting

confidence: 92%

“…21 Heterotopic ossification (7-9%) is a significant problem after ORIF of distal humerus fractures, causing stiffness and pain which calls for reoperation. 5,12,18,19,21,23 In our series, one patient formed heterotopic bone requiring excision with subsequent improvement in motion. Infection rates are reported from 6 to 15% based on two large systematic reviews of distal humerus fractures.…”

Section: Discussionmentioning

confidence: 73%

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Skinny wire and locking plate fixation for comminuted intra-articular distal humerus fractures: a technical trick and case series

Olson¹,

Dyer²

2021

JSES Reviews, Reports, and Techniques

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Intra-articular distal humerus fractures present a challenge to orthopedic surgeons. Stable fixation is difficult to achieve in fractures with articular and metaphyseal comminution and osteoporotic bone. Hence, these fractures are more commonly being managed with total elbow arthroplasty. We describe a novel surgical technique that confers stable fixation, allowing for early range of motion resulting in a high rate of union, a functional range of motion, and excellent patient reported outcome scores without the activity restrictions of total elbow arthroplasty. Methods: Retrospective case series of 30 patients with AO/OTA type B and C intra-articular distal humerus fractures who underwent ORIF from 2014-2019 utilizing a novel surgical technique that focuses on reconstructing a comminuted articular surface through meticulous, transverse fixation of the tiny articular fragments with long, thin Kirchner wires, which are then bent over and trapped under locking compression plates to create a fixed angle support to the metadiaphysis. Results: Patient mean age of 59 (19-90) years and 61% were female. Median follow up was 1.2 years. Twenty-seven (87%) were type C fractures and 3 (13%) were type B. Five patients (16%) suffered a concurrent ipsilateral upper extremity injury and four (13%) had an open fracture. Two were polytrauma patients. All fractures healed with an average time to union of 11 weeks. Over 80% patients reported no or mild pain at final follow up. Mean arc of elbow motion was 102 degrees, mean QuickDASH score 25.2. Post-operative complications included ulnar nerve paresthesias (38%), wound infection (3.2%), heterotopic ossification (3.2%), and olecranon nonunion (3.2%). Eight patients underwent secondary procedures: 7 (23%) removal hardware, 3(9.6%) capsular release, 2 (6.4%) ulnar nerve transpositions, and 1 (3.2%) total elbow arthroplasty. Conclusion:We describe a novel surgical technique that we believe results in strong, stable fixation of complex intra-articular distal humerus fractures irrespective of bone quality. In our series, all fractures healed and post-operatively patients reported low levels of pain, achieved excellent elbow range of motion, high patient reported outcome scores. Patients should be counseled about high rates of postoperative ulnar nerve paresthesias that can be expected to improve over time and high reoperation rates for symptomatic hardware.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 73%

Skinny wire and locking plate fixation for comminuted intra-articular distal humerus fractures: a technical trick and case series

Olson¹,

Dyer²

2021

JSES Reviews, Reports, and Techniques

View full text Add to dashboard Cite

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“…Infection seems to occur due to swelling; soft tissue damage after trauma; or shear force during early range of motion or due to the large volume of the dual plate, which can irritate the skin because the elbow joint has thin soft tissue. In our study, the infection rate of the ORIF group (7.1%) was not as high as reported in other researches [ 25 ]. Proper soft tissue control during the operation should be ensured.…”

Section: Discussionsupporting

confidence: 50%

Comparison of open reduction and internal fixation with total elbow arthroplasty for intra-articular distal humeral fractures in older age: a retrospective study

Baik

Lee

Kang

et al. 2020

Clin Shoulder Elbow

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Background: Intra-articular distal humeral fractures can be surgically challenging. It remains under discussion whether open reduction internal fixation (ORIF) or total elbow arthroplasty (TEA) is more beneficial for treatment of the elderly. This study aimed to compare the clinical and functional outcomes of ORIF and TEA for managing intra-articular distal humerus fractures in patients aged 65 years or older.Methods: Patients who underwent ORIF (n=28) or TEA (n=43) for in intra-articular distal humerus fracture between May 2008 and December 2018 were reviewed. Range of motion, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, radiologic outcomes, and surgical complications were evaluated at the final follow-up visit.Results: The ORIF and TEA groups showed a mean arc of flexion–extension of 97°±21° and 101°±12°, respectively. The mean MEPS and DASH scores were 94±15 and 27±12 points, respectively, in the ORIF group and 81±27 and 47±28 points in the TEA group. This difference was statistically significant. The incidence of total complications was similar between the groups.Conclusions: In patients older than 65 years with intra-articular distal humerus fracture, ORIF had better outcomes than TEA.

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“…The most frequent complication is the malunion, the incidence being over 30% of the overall complications (ulnar neuropathy, nonunion, infection etc.) [12], [20]. Factors such as blood supply of the metaphysis, quality of reduction, the lack of patient surveillance immediately post operator can influence the development of malunion.…”

Section: Introductionmentioning

confidence: 99%

Hyperextension Malunion of the Distal Humerus - Chevron Osteotomy: A Case Report

Necula

Balogh-Ungureanu

2020

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"Treatment of hyperextension malunions of the distal humerus is done by osteotomy, several types being described in the literature. The aim of the paper is to highlight the possibility of using Chevron-type osteotomy in sagittal malunions of the distal humerus shaft. The patient presented in this case report has suffered multiple interventions after a 13C1 AO/OTA fracture of her right arm. When the malunion was identified her range of motion (ROM) was 40-90 degrees flexion. We have performed a supracondylar sagittal Chevron osteotomy at a 30 degrees angle open anteriorly. After the surgery, her ROM improved to 40-135 degrees flexion. The authors chose the Chevron osteotomy because it created an increased area (by 30%) of the interface between the two fragments and offers a good rotational stability. Unfortunately, information in the literature is limited and future studies must be done to endorse the usage of Chevron osteotomy in hyperextension malunion of the distal humerus."

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Complications of open reduction and internal fixation of distal humerus fractures

Cited by 41 publications

References 71 publications

Skinny wire and locking plate fixation for comminuted intra-articular distal humerus fractures: a technical trick and case series

Skinny wire and locking plate fixation for comminuted intra-articular distal humerus fractures: a technical trick and case series

Comparison of open reduction and internal fixation with total elbow arthroplasty for intra-articular distal humeral fractures in older age: a retrospective study

Hyperextension Malunion of the Distal Humerus - Chevron Osteotomy: A Case Report

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