Surgical Treatment of Comminuted Coronal Shear Fracture of Distal Humerus

Abstract

Objective: To investigate the surgical approach, fixation, and clinical effect of comminuted coronal shear fracture of distal humerus. Methods: From March 2017 to February 2019, we had used open reduction and internal fixation to treat 19 cases of comminuted distal humeral coronal shear fracture. There were 8 males and 11 females, with an average age of 44.6 years (19-72 years). There were 10 cases on left side and 9 cases on right side. All cases were closed fractures. According to Dubberley's classification, there were six cases of type 1, six cases of type 2, and seven cases of type 3. The lateral Kocher approach, extended Kocher approach, extended Kocher approach combined with a medial incision and the olecranon osteotomy approach were used for exposure. Headless screw, Kirschner wire, and suture were used to fix the fractures. Two cases were fixed with hinged elbow fixators additionally. The follow-up was evaluated by Mayo Elbow Performance Score (MEPS). Results: All patients were followed up for an average of 17.1 months (range, 12 to 30 months). The average time of fracture union was 8.8 ± 1.9 weeks. There were three cases of degenerative osteoarthritis of elbow and one case of heterotopic ossification after operation. A total of 10 patients underwent removal of implants. At the last follow-up, the elbow flexion-extension arc was 130.5 ± 10.5. The forearm rotation arc was 167.4 ± 6.1. The MEPS was 85.8 ± 8.5, the results were classified as excellent in nine cases, good in eight, and fair in two. The excellent and good rate was 89.5%. The time of fracture union of type 1 was shorter than type 3 (P = 0.024), the elbow flexionextension arc of type 1 fracture was better than type 2 (P = 0.043) and type 3 (P = 0.012), the forearm rotation arc of type 1 fracture was better than type 3 (P = 0.006), the MEPS of type 1 fracture was better than type 2 (P = 0.009) and type 3 (P = 0.002). Conclusion: Open reduction and internal fixation with headless screw, Kirschner wire, and suture can be used for the treatment of comminuted distal humeral coronal shear fractures. The elbow joint function can be restored satisfactorily.

Long-Term Functional Outcomes and Complications of Intra-Articular (AO type B, C) Distal Humerus Fractures in Adults: A Retrospective Review

“…Coronal shear fractures of the distal humerus (type B) pose a substantial challenge as reduction and stabilization are usually demanding [ 4 , 26 , 27 ]. Mighell et al reported on 18 patients at a mean follow-up of 26 months; the average arc of motion was 128° and the mean Morrey score was 93.3; three patients developed avascular necrosis and five, posttraumatic arthritis [ 26 ].…”

“…Teng and Zhong reviewed 19 patients with the mean elbow flexion‐extension arc 130.5° and the mean MEPS 85.8. Three patients developed degenerative osteoarthritis and one case heterotopic ossification; a total of 10 patients (53%) underwent removal of implants [ 27 ]. Finally, Ashwood et al, in a study of 26 patients who were assessed at mean 46 months postoperatively reported excellent results in nine patients, good in nine, and fair in eight; six patients had altered their roles from manual to administrative work.…”

Comparison of the Posterior-anterior Approach and Lateral-medial Approach for Complex AO/OTA Type C Intra-articular Fractures of Distal Humerus

“…Studies have reported that the rate of symptomatic hardware that necessitated re-operation for removal ranges from 8-13% [30,31] in osteotomies secured with K-wire/tension band technique. Recently, Wei et al have reported that a total of ten patients (52.6%) underwent removal of implants, which suggested that the rate of reoperation using K-wire in the treatment of comminuted distal humeral coronal shear fracture was greater than when using other internal xations [40]. Despite most of the studies emphasizing that the K-wire/tension band technique has a high incidence of symptomatic hardware, its speci c time of occurrence is not indicated.…”

Capitellum and trochlea fractures. A systematic review of the literature

“…3 It is documented in the literature that the outcome of type 2A and 3A capitellum and trochlea fractures does not differ significantly. 4 On the other hand there is evidence that Dubberley type B fractures have a negative impact on the outcome and the range of motion of the elbow (ROM). 3,4 The goal of treatment is to achieve an anatomical reduction and stable fixation.…”