Outcome of Extra-Articular Distal Humerus Fractures Fixed by Single Column Extra-Articular Distal Humerus Locking Compression Plate Using Triceps Sparing Postero-Lateral Approach

Abstract

Objective: To determine the time to radiological union and final functional outcome of fixation of extra-articular distal humeral fractures with extra-artricular distal humerus locking plate.

Methods: This prospective study was conducted from March 2014 to February 2018 and included extra-articular distal humeral fractures managed by operative fixation using extra-articular distal humerus locking plate. All the fractures were approached using lateral para-tricepetal approach of Gervin, and stabilized with extra-articular distal humerus locking plate with or without lag screws. Time to radiological union was assessed in the follow up and at the final follow up functional outcome was evaluated using Mayo Performance Elbow Score (MEPS). Complications and need for any additional procedures was also recorded.

Results: A total of 20 patients with mean age of 36.5 years and an average follow up of 17 months were included. The mean time to radiological union was 17.4 weeks (12 to 36 weeks) which included one delayed union that required bone grafting. The mean flexion at elbow was 127o with only one patient having flexion extension arc movement of less than 100o at the final follow up. The average MEPS at final follow up was 94.7±8 with 19 patients having excellent and good results.

Conclusion: Use of extra-articular distal humeral locking plate using lateral para-tricepetal approach in extra-articular distal humeral fractures allows stable fixation of the fracture to allow early return to function with minimal soft tissue dissection and excellent final functional results and minimum complications.

Keywords: Elbow; Extra-articular; Fracture; Humerus; Locking plate.

Fig. 1

Intra-operative pictures. A) Fracture fixed with EADHLCP with radial nerve (R) running over the plate, triceps muscle (T) dissected from lateral septum and posterior aspect of humerus and reflected medially. The proximal part (P) of the plate rests on center of the shaft of humerus and distal part (D) rests on posterior part of lateral column of distal humerus. B) Triceps muscle repositioned covering the plate

Fig. 2

Pre-operative radiograph showing EADHF with a butterfly fragment (A). Intra-operative image after stabilization with a lag screw and EADHLCP (B). Post-operative radiographs showing the butterfly fragment fixed and stabilized to distal fragment with a lag screw and the main fracture reduced and fixed using EADHLCP (C and D)

Fig. 3

Stainless steel EADHLCP having a distal (D) angular offset that rests on lateral column of distal humerus and proximal part (P) with combi holes that rests on the center of the shaft, with different plates for right (R) and left (L) side

Fig. 4

Case No. 2. Pre-operative radiograph (AO type 12-A2) (A). Post-operative radiograph showing anatomical reduction (B). Final follow up radiograph showing radiological union (C)