Outcome of management of distal humerus fractures by locking compression plate

Abstract

Background: Distal humerus fracture is one of the commonest fractures among young adults and which accounts for about 30% of all elbow fractures. The treatment of these fractures continues to the challenges for orthopedics despite of many advances in technique and implants. Different modalities like 1/3rd tubular plate, reconstruction plate, K wires, double tension band wiring, etc, have been tried. The new distal humerus locking compression plate (LCP) system allows angular stable fixation of these complex fractures with anatomically pre-shaped plates. Aims: Aim of this study is to assess the benefits of using locking compression plate (LCP) in the management of distal humerus fractures clinically and as well as functionally. Materials and Methods: A prospective study of 30 adult patients with closed distal humerus fractures were treated by locking compression plate in the department of Orthopaedics, RIMS, Ranchi, between June 2014 to Sep 2015. Variables of each patient were recorded and analysed with respect to age, sex, fracture type, mode of injury, limb involvement, associated injuries, timing and duration of operation, duration of hospital stay, follow up, complications and final outcomes. These patients were followed up at different intervals i.e. at 3 weeks for first 3 months, then at 6-weeks interval for next 6 months and then at 3-month interval. Results: The average age was 38.5 years and majority patients were men (60%). The right humerus was involved in majority (70%) of patients. The complete union was achieved in all patients which was confirmed by radiographically. Average time interval between admission of patients and surgery was 7.8 days (range 4-13 days). The average operative time was 82 minutes (range 70-100 min). All the fractures as well as the olecranon osteotomies united at 12-18 weeks (average 13.80 weeks). There were no any case of primary malposition or secondary dislocation was observed. Using the Mayo elbow performance score, the majority (53.33%) of patients were graded as excellent. There was no any patient reported with deep infection, implant failure, non-union of fracture site or olecranon osteotomy site. There were only three patients those reported superficial wound infection, which was treated with antiseptic dressing and antibiotics. Transient ulnar nerve palsy developed in only 2 (6.66%) cases and both were recovered with conservative treatment. Conclusion: Findings can be concluding that the treatment of distal humerus fractures is a challenging task. Anatomically pre-shaped distal humeral locking compression plate system facilitates operative reduction and stabilization of the fracture and may allow with good range of motion, and flexion and extension force.