Open Access, Peer-reviewed, Quarterly
pISSN 1225-1682
eISSN 2287-9293
    J Korean Fract Soc. 2010 Apr;23(2):194-200. Korean.
    Published online Apr 30, 2010.
    https://doi.org/10.12671/jkfs.2010.23.2.194
    Copyright © 2010 The Korean Fracture Society
    Original Article

    Double Parallel Plates Fixation for Distal Humerus Fractures

    Young Hak Roh, M.D., Moon Sang Chung, M.D., Ph.D., Goo Hyun Baek, M.D., Ph.D., Young Ho Lee, M.D., Ph.D., Hyuk-Jin Lee, M.D., Joon Oh Lee, M.D., Kyu-Won Oh, M.D. and Hyun Sik Gong, M.D., Ph.D.
      • Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
    • Address reprint requests to: Hyun Sik Gong, M.D., Ph.D. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 300, Gumi-dong, Bundang-gu, Seongnam 463-707, Korea. Tel: 82-31-787-7198, Fax: 82-31-787-4056, Email: hsgong@snu.ac.kr
    Received December 08, 2009; Accepted February 08, 2010.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Purpose

    The purpose of this study was to review the outcome of fixation of distal humerus fractures using recently-introduced double parallel plate system in sagittal plane.

    Materials and Methods

    From May 2004 to June 2008, seventeen patients with distal humerus fractures underwent primary open reduction and internal fixation with double parallel plates. According to the AO classification, there were 2 A3, 2 C1, 7 C2, and 6 C3 type fractures. Outcome assessment was performed by using the Mayo Elbow Performance index (MEPI).

    Results

    At a mean follow up of 18 (range, 12 to 32) months, 4 patients were rated as excellent, 8 as good, and 5 as fair in terms of MEPI. The average arc of elbow flexion after primary operation was 116 (range, 90~140) degrees with a mean flexion contracture of 13 (range, 0 to 30) degrees. One patient required reoperation due to fixation failure and six patients underwent capsulolysis and three patients underwent ulnar nerve neurolysis. The time to begin elbow motion exercise had negative correlation with total elbow range of motion and multiple trauma patients had significantly lower MEPI functional score compared to those without combined injury.

    Conclusion

    Double parallel plating allowed adequate fixation for distal humerus fractures regardless of patient age and fracture pattern. Partial ankylosis and unlar nerve compression symptoms were the main causes of reoperation.

    Keywords
    Distal humerus fracture; Double plate; Parallel plate

    Figures

    Fig. 1
    (A) Anteroposterior and lateral radiograph of elbow in a 31-year-old women show intra-articular fracture of distal humerus.

    (B) 3-dimensional CT shows AO/ASIF C3 type fracture of distal humerus.

    (C) Postoperative anteroposterior and lateral radiograph.

    Fig. 2
    (A) Anteroposterior and lateral radiograph of elbow in a 62-year-old women show intra-articular fracture of the distal humerus.

    (B) 3-dimensional CT shows AO/ASIF C2 type fracture of distal humerus.

    (C) Initial postoperative anteroposterior and lateral radiograph.

    (D) At fifteen days after initial operation, the patient slipped down and came to the clinic complaining the elbow pain. Radiographic images show fixation failure of the distal humerus.

    (E) Postoperative radiographs after second operation.

    References

      1. Ackerman G, Jupiter JB. Non-union of fractures of the distal end of the humerus. J Bone Joint Surg Am 1988;70:75–83.
      1. Ahn HS, Cho YH, Byun YS, Kwon DY, Nam SO, Kim DY. Elbow function and complications after internal fixation for fractures of the distal humerus. J Korean Fract Soc 2006;19:56–61.
      1. Aitken GK, Rorabeck CH. Distal humeral fractures in the adult. Clin Orthop Relat Res 1986;(207):191–197.
      1. Ali A, Douglas H, Stanley D. Revision surgery for non-union after early failure of fixation of fractures of the distal humerus. J Bone Joint Surg Br 2005;87:1107–1110.
      1. Arnander MW, Reeves A, MacLeod IA, Pinto TM, Khaleel A. A biomechanical comparison of plate configuration in distal humerus fractures. J Orthop Trauma 2008;22:332–336.
      1. Cho JH, Kim JY, Lee SL, Han KJ. Surgical treatment of intercondylar fractures of the humerus with posterior plates. J Korean Soc Surg Hand 2008;13:212–216.
      1. Holdsworth BJ, Mossad MM. Fractures of the adult distal humerus. Elbow function after internal fixation. J Bone Joint Surg Br 1990;72:362–365.
      1. Jacobson SR, Glisson RR, Urbaniak JR. Comparison of distal humerus fracture fixation: a biomechanical study. J South Orthop Assoc 1997;6:241–249.
      1. John H, Rosso R, Neff U, Bodoky A, Regazzoni P, Harder F. Operative treatment of distal humeral fractures in the elderly. J Bone Joint Surg Br 1994;76:793–796.
      1. Jupiter JB. Complex fractures of the distal part of the humerus and associated complications. Instr Course Lect 1995;44:187–198.
      1. Jupiter JB. The management of nonunion and malunion of the distal humerus--a 30-year experience. J Orthop Trauma 2008;22:742–750.
      1. Jupiter JB, Mehne DK. Fractures of the distal humerus. Orthopedics 1992;15:825–833.
      1. Kundel K, Braun W, Wieberneit J, Rüter A. Intraarticular distal humerus fractures. Factors affecting functional outcome. Clin Orthop Relat Res 1996;(332):200–208.
      1. Moon ES, Rowe SM, Seon JK, Kim MS, Cho SB. Treatment in distal humerus fracture with anatomical Y plate. J Korean Fract Soc 2004;17:76–82.
      1. O'Driscoll SW. Optimizing stability in distal humeral fracture fixation. J Shoulder Elbow Surg 2005;14:186S–194S.
      1. Oh JR, Yoon YS, Lee DK, Her MS. Comminuted intercondylar fracture of the distal humerus in adults. J Korean Fract Soc 2006;19:208–214.
      1. Pajarinen J, Björkenheim JM. Operative treatment of type C intercondylar fractures of the distal humerus: results after a mean follow-up of 2 years in a series of 18 patients. J Shoulder Elbow Surg 2002;11:48–52.
      1. Ring D, Jupiter JB. Complex fractures of the distal humerus and their complications. J Shoulder Elbow Surg 1999;8:85–97.
      1. Ring D, Jupiter JB. Fractures of the distal humerus. Orthop Clin North Am 2000;31:103–113.
      1. Ring D, Jupiter JB, Gulotta L. Articular fractures of the distal part of the humerus. J Bone Joint Surg Am 2003;85-A:232–238.
      1. Rueger JM, Rucker A, Briem D. Distal fracture of the humerus. Chirurg 2007;78:959–971.
      1. Sanchez-Sotelo J, Torchia ME, O'Driscoll SW. Complex distal humeral fractures: internal fixation with a principle-based parallel-plate technique. J Bone Joint Surg Am 2007;89:961–969.
      1. Sanchez-Sotelo J, Torchia ME, O'Driscoll SW. Complex distal humeral fractures: internal fixation with a principle-based parallel-plate technique. Surgical technique. J Bone Joint Surg Am 2008;90 Suppl 2 Pt 1:31–46.
      1. Schemitsch EH, Tencer AF, Henley MB. Biomechanical evaluation of methods of internal fixation of the distal humerus. J Orthop Trauma 1994;8:468–475.
      1. Schwartz A, Oka R, Odell T, Mahar A. Biomechanical comparison of two different periarticular plating systems for stabilization of complex distal humerus fractures. Clin Biomech (Bristol, Avon) 2006;21:950–955.
      1. Self J, Viegas SF, Buford WL Jr, Patterson RM. A comparison of double-plate fixation methods for complex distal humerus fractures. J Shoulder Elbow Surg 1995;4:10–16.
      1. Shin R, Ring D. The ulnar nerve in elbow trauma. J Bone Joint Surg Am 2007;89:1108–1116.
      1. Song KW, Lee SY, Shin SI, et al. Treatment of intercondylar fracture of distal humerus in adult. J Korean Fract Soc 2006;19:62–66.
      1. Soon JL, Chan BK, Low CO. Surgical fixation of intra-articular fractures of the distal humerus in adults. Injury 2004;35:44–54.
      1. Stoffel K, Cunneen S, Morgan R, Nicholls R, Stachowiak G. Comparative stability of perpendicular versus parallel double-locking plating systems in osteoporotic comminuted distal humerus fractures. J Orthop Res 2008;26:778–784.
      1. Viola RW, Hanel DP. Early "simple" release of post-traumatic elbow contracture associated with heterotopic ossification. J Hand Surg Am 1999;24:370–380.
      1. Wang KC, Shih HN, Hsu KY, Shih CH. Intercondylar fractures of the distal humerus: routine anterior subcutaneous transposition of the ulnar nerve in a posterior operative approach. J Trauma 1994;36:770–773.
      1. Wong AS, Baratz ME. Elbow fractures: distal humerus. J Hand Surg Am 2009;34:176–190.
    MeSH Terms
    Ankylosis
    Contracture
    Elbow
    Follow-Up Studies
    Humans
    Humerus
    Multiple Trauma
    Range of Motion, Articular
    Reoperation
    Ulnar Nerve
    Metrics
    Share
    Figures
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