Functional outcome of extra-articular distal humerus fracture fixation using a single locking plate: A retrospective study

Trikha, Vivek; Agrawal, Prabhat; Das, Saubhik; Gaba, Sahil; Kumar, Arvind

doi:10.1177/2309499017727948

Cited by 25 publications

(29 citation statements)

References 20 publications

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“…A study by Meloy GM at al. [5] , show that Patients treated with single-column plating had similar union rates and alignment. However, single-column plating resulted in a significantly better range of motion with less complications.…”

Section: Discussionmentioning

confidence: 90%

A prospective study of functional outcome in intra articular distal humerus fracture treated with dual plating

Chouhan¹,

Bhinde²,

Shekhawat³

et al. 2018

Int. J. Orthop. Sci.

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Background: In adults, distal humerus fractures are uncommon and intra-articular, oftenly involve both the medial and lateral columns. Open reduction and surgical fixation with plating gives good results. The aim of this study is to evaluate clinical outcome in intra articular distal humerus fractures treated with dual plating and evaluate the intermediate term results (minimum follow up of two years) of communited intra-articular distal humerus fractures treated with bicolumnar plating with or without olecranon osteotomy in elderly Indian population. Methods: This is a prospective type of study of 20 cases of supracondylar fracture humerus with inter condylar extension treated surgically with dual plating which were admitted to Jaya Aarogya Hospital & Trauma Center, Gwalior, Madhya Pradesh, between 2015 to 2016. All the patients of supra condylar fracture distal humerus with age between 18 to 60 years with medical fitness for surgery were included in the study. Results:The mean age of the patient was 40±2 years, 12(60%) cases were males, and 8(40%) cases were females. Right sided involvement was more frequent in the present study 13(65%) cases. 14(70%) cases sustained fracture due to road traffic accident, 06(30%) cases had a domestic fall. The average duration of surgery was 94±10 mins. The average duration of the radiological union was 14±06 weeks in 12(60%) cases, 15±04 weeks in 5 (25%) cases, 19±05 weeks in 3 (15%) cases. The outcome was calculated using the ASES and DASH scores. The American shoulder and elbow surgeons score showed excellent in 5 (25%) good in 11 (55%) fair in 4(20%) and no poor outcome. Conclusions: For good functional results, precise preoperative planning, adequate surgical approach, anatomical inter fragmentary stabilization, medial-post erolateral plating, and early post-operative physiotherapy help in restoring painless and functional elbow for distal humeral intra-articular fractures. This step-by-step approach results in satisfactory functional results.

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Section: Discussionmentioning

confidence: 90%

A prospective study of functional outcome in intra articular distal humerus fracture treated with dual plating

Chouhan¹,

Bhinde²,

Shekhawat³

et al. 2018

Int. J. Orthop. Sci.

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“…Incidence of distal humeral fractures is on rise due to high velocity road traffic accidents and the elderly women with osteoporosis is the most vulnerable group [ 21 , 22 ]. Preoperative radial nerve palsy in different studies ranged from 4.3 % to 23.3 % with 15% incidence in our series [ 4 , 5 , 16 , 20 , 21 , 23 ].In all, the radial nerve was intact at the time of surgical intervention and recovered with time. Postoperative radial nerve neuropraxia occurred in 5% of our cases with range of 0% to 8.3% in different series [ 4 , 5 , 20 , 21 , 23 ].…”

Section: Discussionmentioning

confidence: 61%

“…The average time to radiological union in different series using EADHLCP ranged from 12 weeks to 7.3 months with an average of 17.4 weeks in our series [ 4 , 5 , 20 , 21 , 23 , 26 ]. This gross variability may be explained on the basis of different incidence of complex fractures and of open fractures, if included, as well as inter-observer variability in assessing radiological union because of no or minimal callus formation.…”

Section: Discussionmentioning

confidence: 82%

“…Conventional 4.5 mm plates do not allow appropriate number of screw placement in the short distal fragment with added disadvantage of impingement on the olecranon fossa [ 7 ]. Presence of strong torsional strain in this region puts conventional plates at the risk of failure [ 5 , 15 ]. Dual plating improves stability and gives rigid fixation but requires excessive soft tissue stripping with risk of non-union and infection [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, management of extra-articular distal humeral fractures (EADHF) has always been difficult and challenging [ 3 ]. Non-surgical management with hanging cast and bracing is not always a feasible option as the distal fragment is small and difficult to control with a tendency to go into adduction [ 4 ].Associatedmetaphyseal comminution further adds to difficulty of non-surgical treatment [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Outcome of Extra-Articular Distal Humerus Fractures Fixed by Single Column Extra-Articular Distal Humerus Locking Compression Plate Using Triceps Sparing Postero-Lateral Approach

Ali¹,

Mir

Dar

et al. 2018

BEAT

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Objective:To determine the time to radiological union and final functional outcome of fixation of extra-articular distal humeral fractures with extra-artricular distal humerus locking plate.Methods:This prospective study was conducted from March 2014 to February 2018 and included extra-articular distal humeral fractures managed by operative fixation using extra-articular distal humerus locking plate. All the fractures were approached using lateral para-tricepetal approach of Gervin, and stabilized with extra-articular distal humerus locking plate with or without lag screws. Time to radiological union was assessed in the follow up and at the final follow up functional outcome was evaluated using Mayo Performance Elbow Score (MEPS). Complications and need for any additional procedures was also recorded.Results:A total of 20 patients with mean age of 36.5 years and an average follow up of 17 months were included. The mean time to radiological union was 17.4 weeks (12 to 36 weeks) which included one delayed union that required bone grafting. The mean flexion at elbow was 127o with only one patient having flexion extension arc movement of less than 100o at the final follow up. The average MEPS at final follow up was 94.7±8 with 19 patients having excellent and good results. Conclusion: Use of extra-articular distal humeral locking plate using lateral para-tricepetal approach in extra-articular distal humeral fractures allows stable fixation of the fracture to allow early return to function with minimal soft tissue dissection and excellent final functional results and minimum complications.

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Biomechanical evaluation of a modified proximal humeral locking plate application for distal extra‐articular diaphyseal humeral fractures

Lim

Yoon

Choi

et al. 2020

Journal Orthopaedic Research

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The extra-articular distal humerus locking plate (EADHP) is widely used for distal extra-articular diaphyseal humeral fracture fixation. However, it occasionally causes skin prominence and discomfort. The upside-down use of a proximal humerus internal locking system (PHILOS) plate is suggested as an alternative option, but it lacks biomechanical evidence. The purpose of this study was to compare the biomechanical performance between two different fixation methods: the modified use of the PHILOS plate on the anterior cortex versus conventional use of an EADHP on the posterior cortex. Twelve pairs of fresh-frozen cadaveric humeri were used and 7 mm gap osteotomy was performed at 50 mm proximal to the lateral epicondyle to simulate an AO/OTA 12-C1.3 fracture type. Single load to failure was measured after five stiffness tests of the plate-bone constructs in anterior/posterior bending, internal/external torsion, and axial compression. There were no significant differences in metrics between the two groups, except for the load to failure in posterior bending, which was significantly higher for PHILOS (1589.3 ± 234.5) compared to EADHP (1430.1 ± 188.6), p < .023. In conclusion, the modified use of the PHILOS plate showed comparable biomechanical performance compared to the conventional EADHP. The new fixation method offers potential clinical advantages, considering the patient's position and surgical approach at the time of surgery as well as postoperative soft tissue irritation. Therefore, this could be an option for distal humeral extra-articular diaphyseal fracture fixation when the use of EADHP is not suitable or preferred.

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Functional outcome of extra-articular distal humerus fracture fixation using a single locking plate: A retrospective study

Abstract: Stable reconstruction and early initiation of physiotherapy are utilitarian to envision optimal outcome; the use of precontoured extra-articular distal humerus locking plates has yielded satisfactory results with minimal complications in our hands.

Cited by 25 publications

References 20 publications

A prospective study of functional outcome in intra articular distal humerus fracture treated with dual plating

A prospective study of functional outcome in intra articular distal humerus fracture treated with dual plating

Outcome of Extra-Articular Distal Humerus Fractures Fixed by Single Column Extra-Articular Distal Humerus Locking Compression Plate Using Triceps Sparing Postero-Lateral Approach

Biomechanical evaluation of a modified proximal humeral locking plate application for distal extra‐articular diaphyseal humeral fractures

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