International Journal of Orthopaedics Sciences
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International Journal of Orthopaedics Sciences

2019, Volume 5 Issue 1

Clinical study on the management of extra-articular distal humerus fracture treated with extra-articular distal humeral locking compression plate

Author(s): Anshuman Dutta, Anup Jyoti Kotoky, Arun Kumar Sipani and Arup Kumar Daolagupu
Abstract: Background: Extra-articular distal humerus fracture treatment is a controversial topic. One group of surgeons favor non-operative treatment with plaster cast immobilization and functional bracing, while the other favors operative fixation. Concern of radial nerve injury, mal aligned fracture ends and stiffness of the shoulder and elbow following non-operative treatment are the major reasons to opt for an operative fixation. Distal humerus fractures surgeries remain one of the most challenging orthopaedic surgeries. These fractures have a complex anatomy, occurs in osteoporotic bone and are commonly multi-fragmented. The Extra-articular Distal Humeral Locking Compression Plate is a useful treatment option for managing extra-articular distal humerus fractures. Due to the greater screw hole density of the plate distally and using 3.5-mm screws instead of 4.5 mm allows adequate number of screws to be placed to hold the small distal fragment.
Materials and Methods: A prospective clinical study was carried out for a total of 20 cases of extra-articular distal humeral fractures between 18 years and 65 years attending OPD and Emergency Department of Orthopaedics, Silchar Medical College and Hospital who meet inclusion and exclusion criteria from 1st June 2017 to 31st May 2018. All the cases were operated with EADHP. The time for union, range of motion at elbow and complications were recorded in followup. The elbow function was assessed using the Mayo Elbow Performance Score (MEPS) and pain by Visual Analogue Score (VAS).
Results: There were 20 patients (13 males and 7 females) with an average age of 38.85 years. 10 cases were 12B1; 3 cases were 12A1; 2 cases each were 12A2, 12B2 & 12C1 and 1 case was 12C2. The mean time of radiological union was 14.25 weeks. The average duration of follow-up was 9.25 months with a range of 6-12 months. The average range of motion in the study at the 6 months analysis was 0.500 – 125.50. The mean Mayo Elbow Performance Score at the end of 6 months was 95.5, and ranged from 80 to 100. The average visual analogue score was 0.745 cm at the end of 6 months and ranged from 0 to 4cm. All the fractures showed union except one. There was one incidence of plate failure which was reoperated and it got united after 20 weeks of the revision surgery. There were 4(20%) patients who had complications. Two patients had post-operative neuropraxia, one patient had plate failure and in one patient there was loss of 100 extension.
Conclusion: Extra-articular Distal Humeral Locking Compression Plate fixation of distal humerus fractures using the paratricepital approach provides stable fracture fixation with adequate exposure of the radial nerve and 90% of posterior humeral shaft surface.
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