Distal Articular Fractures of the Humerus: Surgical Approach with Dynamic Elbow external Fixator

Abstract

Purpose To measure clinical and radiographic outcomes using external fixation in distal humeral fractures.

Methods A total of 10 elderly patients, with a mean age of 71 (range 64–84 years) years old, with unstable distal humeral fractures were treated by percutaneous reduction and fixation with an articulated external fixator. The patients were assessed on range of elbow motion, patient disabilities of the arm, shoulder, and hand (DASH), and pain visual analog scale (VAS) and radiographic evaluation at 12 months.

Results The mean range of motion was 134° of flexion, extension was of - 5°. All of the elbows were clinically stable. The mean VAS was 2.2, and the mean DASH score was 14.3. Radiographic analysis showed satisfactory reduction and consolidation. All of the patients showed congruence of concentric humerus-ulnar and radius and no patient had joint stiffness or posttraumatic arthritis of the elbow. Regarding complications, we observed a patient who presented with pain in the location of the ulnar pin, which was resolved with the removal of the pin. After two months, another patient had pneumonia and died. The follow-up was of 15.44 months.

Conclusions A radiographic analysis of the patients showed fracture healing with joint congruity. In the functional clinical aspect, it was noted that patients had functional range of motion

Type of study/level of evidence Therapeutic IV

Keywords

elbow - fractures - distal humerus fractures - instability - elderly - external fixation

Ethical Approval

The research presented here was approved by and was in accordance with the ethical standards of the Faculdade de Medicina do ABC Ethics Committee on human experimentation under the CAAE number: 50927715.3.0000.5484.

Informed Consent

An informed consent document was provided to all research participants, who read and signed it according to their will.

• References

• 1 Orbay JL, Mijares MR. The management of elbow instability using an internal joint stabilizer: preliminary results. Clin Orthop Relat Res 2014; 472 (07) 2049-2060
• 2 Ring D, Bruinsma WE, Jupiter JB. Complications of hinged external fixation compared with cross-pinning of the elbow for acute and subacute instability. Clin Orthop Relat Res 2014; 472 (07) 2044-2048
• 3 Lewandowski L, Tintle SM, Daniel C, O'Daniel JA, Fleming M, Keeling J. Circular external fixation for treatment of distal humerus fractures: case report. J Hand Surg Am 2013; 38 (06) 1155-1160
• 4 Ouyang Y, Liao Y, Liu Z, Fan C. Hinged external fixator and open surgery for severe elbow stiffness with distal humeral nonunion. Orthopedics 2013; 36 (02) e186-e192
• 5 Feranec M, Hart R, Kozák T. [Hinged external fixation in orthopaedic and trauma surgery of the elbow]. Acta Chir Orthop Traumatol Cech 2013; 80 (06) 391-395
• 6 Banerjee D, Ghosh S, Ghosh PK, Mitra U, Dasgupta S, Jha AK. A short term experience of management of open and osteoporotic intercondylar fractures of the distal humerus using a mini-external fixator. J Indian Med Assoc 2011; 109 (06) 404 , 406, 408
• 7 Sørensen AK, Søjbjerg JO. Treatment of persistent instability after posterior fracture-dislocation of the elbow: restoring stability and mobility by internal fixation and hinged external fixation. J Shoulder Elbow Surg 2011; 20 (08) 1300-1309
• 8 Stehle J, Gohlke F. [Classification of elbow stiffness and indications for surgical treatment]. Orthopade 2011; 40 (04) 282-290
• 9 Gausepohl T. [Osteosynthesis in distal intra-articular humeral fractures. External fixation with motion capacity]. Unfallchirurg 2011; 114 (02) 130-135
• 10 Allende CA, Allende BT, Allende BL, Bitar I, Gonzalez G. Intercondylar distal humerus fractures--surgical treatment and results. Chir Main 2004; 23 (02) 85-95
• 11 McKee MD, Wilson TL, Winston L, Schemitsch EH, Richards RR. Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach. J Bone Joint Surg Am 2000; 82 (12) 1701-1707
• 12 McKee MD, Jupiter JB. A contemporary approach to the management of complex fractures of the distal humerus and their sequelae. Hand Clin 1994; 10 (03) 479-494
• 13 Aslam N, Willett K. Functional outcome following internal fixation of intraarticular fractures of the distal humerus (AO type C). Acta Orthop Belg 2004; 70 (02) 118-122
• 14 Flinkkilä T, Toimela J, Sirniö K, Leppilahti J. Results of parallel plate fixation of comminuted intra-articular distal humeral fractures. J Shoulder Elbow Surg 2014; 23 (05) 701-707
• 15 Korner J, Lill H, Müller LP. , et al. Distal humerus fractures in elderly patients: results after open reduction and internal fixation. Osteoporos Int 2005; 16 (Suppl. 02) S73-S79
• 16 Hausman M, Panozzo A. Treatment of distal humerus fractures in the elderly. Clin Orthop Relat Res 2004; (425) 55-63
• 17 Cobb TK, Morrey BF. Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients. J Bone Joint Surg Am 1997; 79 (06) 826-832
• 18 Lee KT, Lai CH, Singh S. Results of total elbow arthroplasty in the treatment of distal humerus fractures in elderly Asian patients. J Trauma 2006; 61 (04) 889-892
• 19 Sørensen BW, Brorson S, Olsen BS. Primary total elbow arthroplasty in complex fractures of the distal humerus. World J Orthop 2014; 5 (03) 368-372
• 20 Lovy AJ, Keswani A, Koehler SM, Kim J, Hausman M. Short-Term Complications of Distal Humerus Fractures in Elderly Patients: Open Reduction Internal Fixation Versus Total Elbow Arthroplasty. Geriatr Orthop Surg Rehabil 2016; 7 (01) 39-44