Abstract:Objective To compare effects of three internal fixation techniques in treatment of type C distal humeral fractures. Methods The study involved 75 patients with type C distal humeral fractures undergone double tension band fixation (Group A, n=22), vertical dual-plate fixation (Group B, n=27), or parallel dual-plate fixation (Group C, n=26) between January 2003 and October 2010. According to AO classification of fractures, there were five patients with type C1, 11 with type C2 and six with type C3 in Group A; four with type C1, 13 with type C2 and 10 with type C3 in Group B; seven with type C1, 10 with type C2 and nine with type C3 in Group C. Bilateral approach through triceps brachii or olecranon osteotomy following median incision over posterior elbow was undertaken for all the patients. An analysis was made on indices like fixation modes, elbow range of extension and flexion, and complications. In addition, elbow function was assessed according to the modified Cassebaum scoring system. Results All patients were followed up for average 18 months, which showed bone union without wound infection. At the last follow-up, extension and flexion of the elbow was (122.06±13.13)° in Group A, (118.70±12.37)° in Group B, and (119.90±11.79)° in Group C respectively, with no significant differences among groups (P>0.05). Overall excellence rate was 82% in Group A, 85% in Group B and 85% in Group C, respectively (P>0.05). Conclusion All three internal fixation techniques can attain a good clinical outcome in treatment of type C distal humeral fracture and satisfy the biomechanical requests of distal humerus.
GUO Yong-zhi,DAI He-ling,ZHAO Jian-wen et al. Efficacy of three internal fixation methods for type C distal humeral fractures: a comparative study[J]. CHINESE JOURNAL OF TRAUMA, 2013, 29(5): 395-400.
[1]Ring D, Jupiter JB. Fractures of the distal humerus. Orthop Clin North Am, 2000, 31(1):103-113.
[2]Eralp L, Kocaoglu M, Sar C, et al. Surgical treatment of distal intraarticular humeral fractures in adults (AO type C). Int Orthop, 2001, 25(1):46-50.
[3]Aslam N, Willett K. Functional outcome following internal fixation of intraarticular fractures of the distal humerus. Acta Orthop Belg, 2004, 70(2):118-122.
[4]燕铁斌. 现代骨科康复评定与治疗技术. 第2版. 北京: 人民军医出版社, 2006:8.
[5]JupiterJB, Neff U, Holzath P, et al. Intercondylar fractures of the humerus. An operative approach. J Bone Joint Surg (Am), 1985, 67(2):226-239.
[6]O’Driscoll SW. The triceps-reflecting anconeus pedicle (TRAP)approach for distal humeral fractures and nonunions.Orthop Clin North Am, 2000, 31(1):91-101.
[7]Archdeacon MT. Combined olecranon osteotomy and posterior triceps splitting approach for complex fractures of the distal humerus. J Orthop Trauma, 2003, 17(5):368-373.
[12]Sanehez-Sotelo J, Torchia ME, O’Driscoll SW. Complex distal humeral fractures:internal fixation with a principle-based parallel-plate technique. J Bone Joint Surg (Am), 2007, 89(5):961-969.
[13]Windolf M, Maza ER, Gueorguiev B, et al. Treatment of distal humeral fractures using conventional implants.Biomechanical evaluation of a new implant configuration. BMC Musculoskel Disord, 2010, 11(1):172-179.
[14]Shin SJ, Sohn HS, Do NH. A clinical comparison of two different double plating methods for intraartielllar distal humerus fractures. J Shoulder Elbow Surg, 2010, 19(1):2-9.
[15]Stoffel K, Cunneen S, Morgan R, et al. Comparative stability of perpendicular versus parallel double-locking plating systems in osteoporotic comminuted distal humerus fractures. J Orthop Res, 2008, 26(6):778-784.
[16]Allende CA, Allende BT, Allende BL, et al. Intercondylar distal humerus fractures-surgical treatment and results.Chir Main, 2004, 23(2):85-95.
[17]Pajarinen J, Bjrkenheim JM. Operative treatment of type C intercondylar fractures of the distal humerus:results after a mean follow-up of 2 years in a series of 18 patients. J Shoulder Elbow Surg, 2002, 11(1):48-52.