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. 2021 Oct 13;22(1):875.
doi: 10.1186/s12891-021-04764-x.

Temporary spanning plate across the elbow for complex fractures of the distal humerus

Ashraf N Moharram  1 , Mostafa Mahmoud  1 , Ahmed Lymona  1 , Ahmed Afifi  1 , Mostafa Ezzat  1 , Mohamed Abdel-Wahed  2
Affiliations

Temporary spanning plate across the elbow for complex fractures of the distal humerus

Ashraf N Moharram et al. BMC Musculoskelet Disord. .

Abstract

Background: Open reduction internal fixation (ORIF) is the gold standard management of fractures of the distal humerus. Stable fixation to allow early mobilization is not always possible in cases with comminuted fracture patterns and bone loss, with a high failure rate. We propose augmentation of internal fixation in these unstable situations with a spanning plate across the elbow to protect the fixation construct temporarily until bone union.

Methods: Eighteen patients with complex distal humeral fractures were managed with standard ORIF technique augmented with a temporary plate spanning across the elbow as an internal fixator. Cases included were either very distal, comminuted (6 cases) or insufficiency fractures (4 cases) or revision fixation cases (8 cases). The temporary spanning plate was removed as soon as signs of early radiographic union were detected.

Results: Seventeen patients were available for final follow up at a mean 28.3 months. The spanning plate was removed after 3.4 months on average. At the final follow-up, the mean elbow total arc of motion was 86.3°. The mean Mayo Elbow Performance Score (MEPS) was 80, and the mean Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score was 27.

Conclusion: Spanning the elbow temporarily with a plate in adjunct to standard ORIF technique is both simple and effective in achieving fracture stability and union and minimizes failure rates after fixation of comminuted, very distal fractures, osteoporotic cases, or revision fixation cases with bone loss.

Level of evidence: Level IV, Therapeutic study.

Keywords: Comminuted articular fractures; Distal humerus; Elbow fractures; Spanning plate.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
X-rays at presentation of a 69 years’ old lady (case #9) with low-laying fracture of the distal humerus that have failed a previous osteosynthesis
Fig. 2
Fig. 2
Postoperative x-rays of the forementioned patient (case #9) fixed with double columns plates and augmented with a temporary spanning elbow plate
Fig. 3
Fig. 3
Same patient (case #9) after removal of the spanning plate 2.5 months later showing adequate union
Fig. 4
Fig. 4
Triceps split (window) to apply the contoured spanning plate. In this patient (case #4) a non-locked DCP was used as a span plate. The triceps split window was relatively larger than usual and was the main window used for osteosynthesis with minimal paratricipital exposure
Fig. 5
Fig. 5
X-rays at presentation of a 19 years’ old female (case #14) with highly comminuted fracture of the distal humerus at the dominant hand
Fig. 6
Fig. 6
X-rays of the forementioned patient (case #14) fixed with preshaped column plate and augmented with a temporary spanning elbow plate. Olecranon osteotomy in this patient was fixed with an intramedullary screw inserted through the plate
Fig. 7
Fig. 7
A reconstruction 3.5 plate was utilized as a spanning plate in this patient (case #14), inserted through a small tricipital window (black arrow) and an intramedullary screw is inserted through the plate to simultaneously fix the olecranon osteotomy. The fixation on the ulna side needed only a small window (grey arrow) to insert the screws. The ulnar nerve was released in situ (white arrow)
Fig. 8
Fig. 8
Follow up X-ray for the same patient (case #14) 9 months after spanning plate removal showing good union
Fig. 9
Fig. 9
The same posterior approach was utilized to remove the spanning plate. In this patient (case #14) the spanning plate was removed after 3 months
Fig. 10
Fig. 10
Gentle manipulation at time of removal of the spanning plate (case #14) with a functional range of motion achieved easily on table
See this image and copyright information in PMC

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