Outcomes of distal humerus diaphyseal injuries fixed with a single-column anatomic plate

Abstract

Purpose: The locking compression extra-articular distal humerus plate (EADHP) is an anatomically shaped, angular stable single-column fixation system for distal third humerus fractures. The purpose of this retrospective study was to evaluate clinical and radiographic outcomes after open reduction and internal fixation of distal humerus fractures with this device.

Methods: Twenty-one consecutive patients with distal humerus fractures were treated with the EADHP system between February 2006 and June 2012. Of these, 19 were clinically and radiographically evaluated after a mean follow-up of 10.4 months. Follow-up assessment included anteroposterior and lateral radiographs, assessment of range of motion (ROM), pain according to a visual analogue scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) score.

Results: All fractures demonstrated satisfactory reduction and healing at an average of 7.3 months. One patient showed post-operative sensory ulnar neuropathy that recovered completely, and nine patients had a preoperative radial nerve palsy, which recovered spontaneously following exploration and plating. Mean post-operative ROM was as follows: flexion 126°, extension -7°, pronation 82° and supination 83°. The VAS score was zero points in eight patients, while the mean DASH score was 25.8 points.

Conclusions: For extra-articular distal humerus fractures, including high-energy injuries often seen in gunshot wounds or motor vehicle injuries, the anatomically shaped angular stable single-column plate provides satisfactory clinical and radiographic results and serves as a valuable tool in the treatment of these injuries.

Fig. 1

Intra-operative photograph of the posterolateral approach with identification of the posterior brachial cutaneous nerve (white arrow) and radial nerve (black arrow)

Fig. 2

Intraoperative view of the EADHP system placed on the distal humerus. Note the radial nerve crossing the plate at the mid-shaft of the humerus (black arrow)

Fig. 3

General position and extent of the EADHP implant. a Anteroposterior humerus. b Lateral humerus. c Anteroposterior elbow. d Lateral elbow radiographs. Note the proximal extension of the plate. The humerus and elbow radiographs are from two different cases

Fig. 4

Anteroposterior and lateral radiographic angles of the elbow. a Metaphyseal-diaphyseal angle (α), humeral-ulnar angle (β). b Shaft-condylar angle (arrow), the anterior humeral line (A)