Condylar orientation plating in comminuted intraarticular fractures of adult distal humerus

Abstract

Background: The condyles of the distal humerus have characteristic orientation in reference to the diaphysis. Anatomical reduction of the articular surface in intraarticular fractures of adult distal humerus does not always restore preinjury functional status. The purpose of this study was to determine the outcome of treating these fractures with technique of condylar orientation precontoured plating. The principle of the technique is to primarily restore the anatomical orientation of the reconstructed distal humeral condyle with the diaphysis of the humerus apart from anatomical reduction of fracture.

Materials and methods: Seventy one consecutive patients with comminuted intraarticular adult distal humerus fractures were treated with the condylar orientation plates, which were specifically designed between 1999 and 2009. 43 fractures were Association for osteosynthesis (AO) type C3, 24 were C2 and 4 were C1. Six were open cases and two were of nonunion distal end humerus. On medial and posterolateral side of the distal humerus, precontoured Sherman plates were applied. Patients were followed up for a mean of 3 years. They were assessed clinically (using mayo elbow performance score [MEPS]) and radio-graphically.

Results: Sixty (84.5%) patients regained MEPS of 90 or more that is an excellent result (range of movement and functional status). One patient had nonunion with implant failure, and two patients developed heterotopic ossification. The mean MEPS was 95. Average extension and flexion was 15° and 133°. The result was graded as excellent in 60, good in 7, fair in 3 and poor in 1. At the time of most recent followup, 63 elbows were painless, and eight had mild pain.

Conclusion: Excellent pain free range of motion with a high rate of union can be achieved in comminuted intraarticular distal humerus fractures in adults with the use of condylar orientation precontoured plating technique. Condylar orientation is very important with perfect articular congruity in elbow motion.

Keywords: Bone; Comminuted fracture; bone plates; distal humerus; fracture fixation; fractures; humeral condylar fracture; humerus; intraarticular fracture; precontoured plating.

Figure 1

(a) Photograph of distal humerus from side showing anterior humeral angle (b) Photograph of distal humerus from front showing tilt of metaphysis in the coronal plane

Figure 2

(a) Diagrammatic end view as seen from the lower end to show the relationship of the distal humerus with the head CD: Line passing through epicondyles. O: End on view axis of the shaft. YOB: Acute angle used to measure retroversion (b) Photograph of distal end humerus in the axial plane showing the distal humeral articular surface is 5-7° internally rotated in reference to the line connecting the epicondyles

Figure 3

Photograph of distal humerus side view showing condylar orientation plate placed on the posterolateral surface. It should end above the articular surface (b) Photograph of distal humerus front view showing medial and posterolateral plate in place

Figure 4

(a) X-ray anteroposterior view of distal humerus with elbow joint showing comminuted intercondylar fracture (b) Postoperative radiograph anteroposterior and lateral views showing union of fracture

Figure 5

Clinical photographs showing range of motion