Promising results after the treatment of simple and complex distal humerus type C fractures by angular-stable double-plate osteosynthesis

摘要

Introduction. -The aim of this study was to evaluate the functional results and complications followintfopen reduction and internal fixation of distal humerus type C fractures (AO classification) using an anatomically precontoured, angular-stable double-plate system. Patients and methods. -The study is a retrospective analysis of 45 patients with 46 type C fractures. There was 1 C1, 8 C2 and 31 C3 fractures. Twelve fractures were open (Gustilo classification). Follow-up was performed on 38 patients with 39 fractures (84%) after 14 months (range, 12-22). The mean age was 50 years (range, 14-87). Functional results were evaluated using the Mayo Elbow Performance Score (MEPS); the Disabilities of the arm, shoulder and hand score (DASH); and range of motion (ROM) measurements. Complications were classified as minor or major, and the postoperative and follow-up X-rays were analyzed. Results. -Thirty-four fractures were considered stable to allow early physical therapy. With a mean MEPS of 85 points, 36 results (36/39 [92%]) were rated as excellent or good. The mean DASH was 22.5 points, and the ROM for extension flexion was 105deg (range, 50-145). Sixteen major complications (eventually coexistent: 6x implant failure, 3x non-union, 6x stiffness, 2x necrosis capitulum, 4x failure olecranon osteotomy refixation) and two minor complications were recorded in 17 patients. These adverse events led to 14 revision surgeries (14/39 [36%]). Except for extension deficit, no statistically significant differences were found between the articular simple and articular complex fractures and when comparing the results between patients with and without a major complication. Conclusion. -The anatomically precontoured and angular-stable double-plate system provides sufficient immediate postoperative stability to allow early physiotherapy, even in C3-type fractures. Excellent or good results could be achieved in the vast majority of patients, independent on having suffered a complication or not. Complication rates were remarkably high, emphasizing the difficulties associated with this rare type of fracture. Level of evidence: Level IV Retrospective study.