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. 2022 Jan-Apr;17(1):7-13.
doi: 10.5005/jp-journals-10080-1546.

Double Plating in Type C Distal Humerus Fractures: Current Treatment Options and Factors that Affect the Outcome

Efstratios D Athanaselis  1 , Georgios Komnos  1 , Dimitrios Deligeorgis  1 , Michael Hantes  1 , Theofilos Karachalios  1 , Konstantinos N Malizos  1 , Sokratis Varitimidis  1
Affiliations

Double Plating in Type C Distal Humerus Fractures: Current Treatment Options and Factors that Affect the Outcome

Efstratios D Athanaselis et al. Strategies Trauma Limb Reconstr. 2022 Jan-Apr.

Abstract

Purpose: This is a retrospective cohort study of type C distal humeral fractures (AO classification system) aimed at evaluating the effectiveness of current operative treatment options.

Materials and methods: Thirty-seven patients with type C distal humeral fractures, treated operatively from January 2002 to September 2016, were retrospectively studied. Thirty-two were eligible for inclusion. Patients were treated by open reduction using the posterior approach, olecranon osteotomy and parallel-plate two-column internal fixation. Patients were evaluated for fracture healing, functional outcomes and complications (infection, ulnar neuropathy, heterotopic ossification and need for implant removal). Restoration of the normal anatomy was defined by measuring carrying angle, posterior angulation and intercondylar distance of distal humerus.

Results: The mean follow-up time was 8.7 years [range 2-15.5 years, standard deviation (SD) = 3.96]. Mean time to fracture union was 8 weeks for 29 patients (90.6%) (range, 6-10 weeks). In nine cases, there was malunion of varied importance (28.1%). There was one case with postoperative ulnar neuropathy and one case with deep infection. The mean Disabilities of the Arm, Shoulder and Hand (DASH) score and mean Mayo Elbow Performance Score (MEPS) were 20 (range 0-49) and 83.3 (range 25-100), respectively.

Conclusion: In complex distal humerus fractures, the posterior approach with olecranon osteotomy and parallel plating of two columns, after anatomic reconstruction of the articular segment, is a prerequisite for successful elbow function.

How to cite this article: Athanaselis ED, Komnos G, Deligeorgis D, et al. Double Plating in Type C Distal Humerus Fractures: Current Treatment Options and Factors that Affect the Outcome. Strategies Trauma Limb Reconstr 2022;17(1):7-13.

Keywords: Distal humeral fractures; Double plating technique; Heterotopic ossification; Olecranon osteotomy; Tension band osteosynthesis; Two-column theory; Ulnar nerve management.

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Conflict of interest statement

Source of support: Nil Conflict of interest: None

Figures

Fig. 1A and B
Fig. 1A and B
Anteroposterior and lateral X-rays of distal humeral fracture of AO type C in a 50-year-old male
Fig. 2A and B
Fig. 2A and B
Two-column internal osteosynthesis and tension band fixation of olecranon osteotomy 11 years postoperatively
Fig. 3
Fig. 3
Flowchart presenting cases according to union and outcome scores
Fig. 4
Fig. 4
Tension band K-wires malpositioning or migration can cause soft tissue complications (e.g. skin irritation and anterior interosseous nerve pressure) leading to the necessity of implant removal surgery
Fig. 5
Fig. 5
Radiographic osteoarthritic findings (osteophytes, subchondral bone sclerosis, joint space narrowing) of a then 45-year-old female patient treated for intra-articular distal humeral fracture, 11 years postoperatively
See this image and copyright information in PMC

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