Treatment of distal humeral fractures by open reduction and internal LCP-DHP fixation

Abstract

PURPOSE OF THE STUDY: The aim of this retrospective study was to evaluate the group of 27 patients with distal humeral fractures treated by the locking compression plate and distal humerus plate (LCP-DHP) system. MATERIAL: Between January 2006 and June 2008, a total of 62 distal humeral fractures (61 patients) were treated in our department, of which 27 were managed by LCP-DHP. The group comprised 15 women (55.5 %) and 12 men (45.5 %), with anaverage age of 53.6 years (range, 18 to 84 years). Methods: Conservative reduction and subsequent immobilization were done in all fractures. The surgical procedure was indicated within 24 hours of injury, with neurological deficit or an open fracture this was 6 hours. Access to the fracture was from a longitudinal dorsal incision with intra-articular osteotomy of the olecranon. The ulnar nerve was released and transposed. The fractures were reduced with an effort of maximal restoration of the articular surface, and then fixed with LCP-distal humerus plates. Antibiotic prophylaxis was administered and the wound was drained and a drain was inserted. The arm was immobilized in a plaster cast or a removable brace for 2 to 4 weeks, according to the fracture type. The patients had clinical and X-ray follow-up at 6 weeks, then at 3, 6 and 12 months after surgery. The evaluation was based on the Mayo elbow performance score (MEPS). RESULTS: The injury was caused by a fall in 24 patients (88.9 %), sustained in a car accident in two (7.4 %) and as the result of a gunshot in one patient (3.7 %). Multiple injuries to the musculoskeletal system were diagnosed in five patients (18.5 %). One patient with polytrauma after a fall from 6 metres suffered an ipsilater fracture of the distal femur (3.7 %). The two patients involved in car accidents (7.4 %) had injury to the contralateral acetabulum. Two patients (7.4 %) sustained distal radial fractures on the other side. Surgery was carried out within 10.5 hours (4 to 47) of injury on the average. The average hospital stay was 6.4 days (2 to 12). All 27 fractures were classified as AO type C fractures, of these seven were open fractures. Complete bony union was achieved at an average of 4 months, with a range of 3 to 9 months (in two patients 7.4 %) after surgery. The early post-operative complications included wound dehiscence due to superficial infection in two patients. In two patients early removal of the implants was indicated, and this was for ulnar nerve irritation and motion range restriction in one and deep infection in the other. No migration or failure of the implants was recorded. The average MEPS of the patient group was 91.6, which is in the range of excellent to very good results. DISCUSSION: The group of our patients is by age, sex and AO type C fractures comparable with the groups of other authors. The number of complications is lower and the MEPS evaluation is comparable. Even when full anatomic reduction and stable fixation are achieved, the outcome may be compromised by heterotrophic ossification, joint rigidity or ulnar neuropathy, the facts described by the majority of authors. Similarly, it is reported that good results are obtained with intra-articular osteotomy of the olecranon and ulnar nerve transposition. An important component of the treatment is good quality physical therapy restoring a satisfactory range of motion. CONCLUSIONS: The study provided evidence that the use of LCP-DHP provides stable fixation of type C fractures, even in patients with osteoporosis, and when completed with early rehabilitation, it has good clinical outcomes.