AO type 13-C Distal Humerus Fractures. Results of Surgical Treatment

Abstract

PURPOSE OF THE STUDY The aim of this retrospective study was to evaluate the results of surgical treatment in 41 fractures of the distal humerus classified as type C according to the AO system using conventional versus angle-stable locking plates. MATERIAL Fifty-one patients were treated by the open reduction and internal fixation method at our department between 2005 and 2008. The group included 28 women and 23 men with an average age of 52.5 years. Forty-one patients came to the final treatment evaluation. The average follow-up was 19 months. Of the 41 injuries, 34% were open fractures. METHODS All patients were operated on from the standard dorsal approach. Olecranon osteotomy was performed in 83% and the Bryan-Morrey procedure was used in 17% of the patients. Stable osteosynthesis with two reconstruction plates was used in 14 patients (34%), two locking distal humeral plates (DHP) in 21 patients (51%) and a reconstruction plate combined with a DHP was employed in six patients (15%).Controlled early passive rehabilitation was started as soon as acute pain after surgery had resolved. Follow-up at 4, 8 and 12 weeks and at 6 and 12 months included clinical and radiographic examination. The functional outcome was assessed using the Mayo Elbow Performance Score (MEPS) system. RESULTS The average MEPS was 83.6 points. Excellent results were recorded in 19 (46%), good in 14 (34%), satisfactory in five (12%) and poor in three (8%) patients. Healing was achieved within 3 months of surgery in 82% and within 4 months in 12% of the patients. Non-union due to failure of osteosynthesis was recorded in 5 % of the patients. No differences were found in the duration of healing in relation to the implant used. The average flexion/extension range of motion (ROM) at the elbow was 108 degrees (range, 40 to 145 degrees). The complications included failure of osteosynthesis in three patients, deep wound infection in two, superficial infection in one and heterotopic ossification in five patients. Of 16 patients (39%) with ulnar nerve irritation, 15 had impairment in sensory function and one in motor function. The average operative time was 163 min. DISCUSSION The results of our study correspond to relevant data reported in the present-day literature. There is an agreement in excellent and good functional outcomes, as assessed using the MEPS, in ROM values and operative time as well as in complications such as non-union, infection or heterotopic ossification. Compared with other studies, the proportion of ulnar nerve irritation in our group was higher. As reported, excellent results are achieved with the use of locking compression plates, particularly in comminuted fractures of the distal humerus in osteoporotic bone. CONCLUSIONS The method of open reduction and internal fixation with two plates performed by an experienced surgeon brings about good results in the treatment of AO type C fractures of the distal humerus.