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

Abstract

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.

Utilization of 1.25mm wire and locking plate fixation for a comminuted low transverse distal humerus fracture, a case report of a 78-year-old woman.

“…Radiographic evidence of fracture healing coincided with the 78-year-old patient's timely reduction in pain and quick recovery of ROM. Olson, Kamrani, and Abdoli reported follow-ups at a year or longer demonstrating elbow arcs of 102°, 99°, and 97° respectively, while this case demonstrates an arc of 117° after just seven weeks of recovery (Olson and Dyer 2021;Kamrani et al 2011;Abdoli, Farhoud, and Kamrani 2020).…”

“…A 78-year-old right-hand dominant retired female presented with a displaced, comminuted, low transverse distal humerus fracture secondary to a fall from standing. Fixation of this fracture was achieved through a slight modification of the skinny K-wire and locking plate technique described by Olson et al in 2021.…”

“…Given the extent of the comminution and bone demineralization, there was concern that traditional ORIF with plate and screw fixation would not sufficiently capture the comminuted fragments. Therefore, utilizing a slight modification of the technique established by Olson et al (Olson and Dyer 2021)., dual locking plates were used in conjunction with skinny K-wires to achieve fractures fixation.…”