Evaluation of the Functional Outcome in Intra-Articular Distal Humerus Fractures Treated by Dual Plating
-
Vinod Bhuktar
,
Mihir Patel
,
Bibhas DasGupta
,
Mahesh Shinde
,
Karthik HK Gowda
,
Kshitij Sarwey
,
Sanket Jethliya
,
Pushti Shah
,
Anika Zaveri
,
Yash Nav Singh
,
Meghana Date
,
Yash Jain
,
Shreyas Revankar
Abstract
Background: The complex anatomy of the elbow joint, multiple displaced fragments, and intra-articular extension of the fracture make these cases challenging to treat and prone to complications. Several methods of limited internal fixation, such as Kirschner wires (K-wires), screw fixation, and single plates, have been described. However, these methods do not provide sufficient stability for early mobilization and often yield unpredictable results. The latest generation of pre-contoured anatomical compression locking distal humerus plate systems offers angular stability and rigid fixation for intra-articular distal humerus fractures. This study aims to evaluate the clinical outcomes of distal humerus fractures using dual plate fixation.
Methods: After ethics committee approval, this prospective observational study was conducted over a period of 26 months on 20 patients with intra-articular distal humerus fractures. Functional outcome was measured by using the Mayo Elbow Performance Score (MEPS) system. Radiological union was checked at regular intervals.
Results: Olecranon osteotomy (65%) showed better outcomes than the paratricipital approach (35%), with 60% of patients achieving excellent MEPS scores at 24 weeks. Radiographic union was observed in 60% of patients by 12-14 weeks, 25% by 16-18 weeks, and 15% by 18-20 weeks [mean ± standard deviation (SD) = 15.00 ± 2.83 weeks]. Mean range of motion (ROM) improved significantly from 65.83 ± 14.89 degrees at 6 weeks to 102.50 ± 15.88 degrees at 24 weeks (P < 0.01). Complications included one case each of wound infection, hardware protrusion, and stiffness, managed with antibiotics or physiotherapy.
Conclusion: The dual locking plating for intra-articular humerus fracture may be a better option in terms of stable and rigid fixation, functional outcome, and fewer complications.
1. Amir S, Jannis S, Daniel R. Distal humerus fractures: a review of current therapy concepts. Curr Rev Musculoskelet Med. 2016;9(2):199-206. doi: 10.1007/s12178-016-9341-z. [PubMed: 27039395]. [PubMed Central: PMC4896884].
2. Ul Islam S, Glover AW, Waseem M. Challenges and Solutions in Management of Distal Humerus Fractures. Open Orthop J. 2017;11:1292-307. doi: 10.2174/1874325001711011292. [PubMed: 29290867]. [PubMed Central: PMC5721336].
3. Van Tunen B, Van Lieshout EMM, Mader K, Den Hartog D. Complications and range of motion of patients with an elbow dislocation treated with a hinged external fixator: a retrospective cohort study. Eur J Trauma Emerg Surg. 2022;48(6):4889-96. doi: 10.1007/s00068-022-02013-x. [PubMed: 35750865]. [PubMed Central: PMC9712317].
4. Reichert IL, Ganeshamoorthy S, Aggarwal S, Arya A, Sinha J. Dislocations of the elbow - An instructional review. J Clin Orthop Trauma. 2021;21:101484. doi: 10.1016/j.jcot.2021.101484. [PubMed: 34367909]. [PubMed Central: PMC8321949].
5. Patel J, Motwani G, Shah H, Daveshwar R. Outcome after internal fixation of intraarticular distal humerus (AO type B & C) fractures: Preliminary results with anatomical distal humerus LCP system. J Clin Orthop Trauma. 2017;8(1):63-7. doi: 10.1016/j.jcot.2017.02.004. [PubMed: PMC5359525]. [PubMed Central: PMC5359525].
6. Yadav V, Sharma P, Gohiya A. Functional outcome of intraarticular distal humerus fracture fixation using triceps- sparing paratricipital approach. Indian J Orthop. 2016;50(6):595-601. doi: 10.4103/0019-5413.193487. [PubMed: 27904213]. [PubMed Central: PMC5122253].
7. Lee H-J. Surgical treatment strategy for distal humerus intra- articular fractures. Clin Shoulder Elb. 2019;22(2):113-7. doi: 10.5397/cise.2019.22.2.113. [PubMed: 33330205]. [PubMed Central: PMC7714297].
8. Iselin LD, Mett T, Babst R, Jakob M, Rikli D. The triceps reflecting approach (Bryan-Morrey) for distal humerus fracture osteosynthesis. BMC Musculoskelet Disord. 2014;15:406. doi: 10.1186/1471-2474-15-406. [PubMed: 25471796]. [PubMed Central: PMC4289245].
9. Zhou SC, Jin SY, Wang QY, Ren GK, Peng CG, Wang YB, et al. Surgical flip-dislocation of the bicolumnar approach without olecranon osteotomy versus olecranon osteotomy in type AO 13C3 distal humeral fracture: a matched-cohort study. J Orthop Surg Res. 2023;18(1):913. doi: 10.1186/s13018-023-04405-0. [PubMed: 38031095]. [PubMed Central: PMC10688126].
10. Holte AJ, Dean RE, Chang G. Distal humerus fractures: review of literature, tips, and tricks. JSES Rev Rep Tech. 2023;4(3): 639-46. doi: 10.1016/j.xrrt.2023.11.004. [PubMed: 39157236]. [PubMed Central: PMC11329030].
11. Cummings JL, Schwabe MT, Rivera AE, Sanders J, Denning JR, Neal K, et al. K-wire Versus Screw Fixation in Displaced Lateral Condyle Fractures of the Humerus in Children: A Multicenter Study of 762 Fractures. J Pediatr Orthop. 2023;43(4):e284-e9. doi: 10.1097/bpo.0000000000002348. [PubMed: 36634213]. [PubMed Central: PMC11216759].
12. Jagadish U, Kumar KV, Shanthappa AH. Functional Outcome of Distal Humerus Fractures Treated With Open Reduction and Internal Fixation With Bicolumnar Plating in a Tertiary Care Setting. Cureus. 2023;15(1):e33540. doi: 10.7759/cureus.33540. [PubMed: 36779108]. [PubMed Central: PMC9907393].
13. Virani SR, Sonone S, Dahapute AA, Panda I, Roy KD. Functional Results of Communited Intra-articular Distal Humerus Fractures Treated with Bicolumnar Plating. J Clin Diagn Res. 2017;11(4):Rc01-rc3. doi:10.7860/jcdr/2017/20777.9666. [PubMed: 28571218]. [PubMed Central: PMC5449864].
14. Jayakumar P, Ring D. A Pitfall in Fixation of Distal Humeral Fractures with Pre-Contoured Locking Compression Plate. Arch Bone Jt Surg. 2015;3(2):130-3. [PubMed: 26110181]. [PubMed Central: PMC4468620].
15. Shih CA, Kuan FC, Hsu KL, Hong CK, Lin CL, Yeh ML, et al. Does posterior configuration have similar strength as parallel configuration for treating comminuted distal humerus fractures? A cadaveric biomechanical study. BMC Musculoskelet Disord. 2021;22(1):440. doi: 10.1186/s12891-021- 04302-9. [PubMed: 33990212]. [PubMed Central: PMC8122534].
16. Saini R, Sharma A, Rathore KS, Sidhu SS. Clinical and Functional Outcomes of Anatomical Plating in Distal Humerus Fractures in Adults. Cureus. 2023;15(2):e35581. doi: 10.7759/cureus.35581. [PubMed: 37007319]. [PubMed Central: PMC10062419].
17. Bahroun S, Grami H, Kacem MS, Aloui A, Jlalia Z, Daghfous MS. Comparative analysis of two double-plate fixation techniques for intercondylar fractures of the distal humerus. Sci Rep. 2024;14(1):23913. doi: 10.1038/s41598-024-73299-7. [PubMed: 39397058]. [PubMed Central: PMC11471842].
18. Athanaselis ED, Komnos G, Deligeorgis D, Hantes M, Karachalios T, Malizos KN, 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. doi: 10.5005/jp-journals-10080-1546. [PubMed: 35734034]. [PubMed Central: PMC9166263].
19. Papen A, Schöttker-Königer T, Schäfer A, Morrison F, Hollinger B, Burkhart KJ, et al. Reliability, validity and critical appraisal of the cross-cultural adapted German version of the Mayo Elbow Performance Score (MEPS-G). J Orthop Surg Res. 2022;17(1):328. doi: 10.1186/s13018-022-03210-5. [PubMed: 35752835]. [PubMed Central: PMC9233775].
20. Wilson ES, Buckwalter JAt, Henning G, Davison J, Fleury IG, Willey MC. Inclusion of Olecranon Osteotomy With the Posterior Approach for Fixation of Distal Humerus Fractures (OTA/AO 13) Does Not Increase Surgical Complications. J Orthop Trauma. 2021;35(7):e223-e7. doi: 10.1097/bot.0000000000002006. [PubMed: 33208714].
21. Jeong HS, Yang JY, Jeon SJ, Shon HC, Oh JK, Lim EJ. Comparison of olecranon osteotomy and paratricipital approach in distal humerus intra-articular fracture: A systematic review and meta-analysis. Medicine (Baltimore). 2022;101(34):e30216. doi: 10.1097/md.0000000000030289. [PubMed: 36042686]. [PubMed Central: PMC9410592].
22. Singh R, Kanodia N, Singh H. Outcome following olecranon osteotomy versus paratricipital approach for complex intra- articular (AO 13-C) fracture of distal humerus: a prospective comparative study. J Shoulder Elbow Surg. 2019;28(4):742-50. doi: 10.1016/j.jse.2019.01.002. [PubMed: 30885311].
23. Singh S, Arif M, Gupta S. Functional outcome of AO type C distal humerus fractures treated with internal fixation using olecranon osteotomy in a tertiary care hospital. Int J Res Med Sci. 2021;9(11):3298-301. doi: 10.18203/2320-6012.ijrms20214051.
24. ElmadagM,ErdilM,BilselK,AcarMA,TuncerN,TuncayI.The olecranon osteotomy provides better outcome than the triceps-lifting approach for the treatment of distal humerusfractures. Eur J Orthop Surg Traumatol. 2014;24(1):43-50. doi: 10.1007/s00590-012-1149-y. [PubMed: 23412273].
25. Park SG, Seok HG. Bi-columnar locking plate fixation through a
combined medial and lateral approach for the treatment of low transcondylar fractures of the distal humerus in the elderly. BMC Musculoskelet Disord. 2022;23(1):764. doi:10.1186/s12891-022- 05594-1. [PubMed: 35948886]. [PubMed Central: PMC9367132].
26. Chouhan S, Bhinde S, Shekhawat Y, Panwar N, Bajoria R. A prospective study of functional outcome in intra articular distal humerus fracture treated with dual plating. Int J Orthop Sci. 2018;4(2):51-5. doi: 10.22271/ortho.2018.v4.i2a.10.
27. Asfuroğlu ZM, İnan U, Ömeroğlu H. Open reduction and internal fixation in AO type C distal humeral fractures using olecranon osteotomy: Functional and clinical results. Ulus Travma Acil Cerrahi Derg. 2018;24(2):162-7. doi: 10.5505/tjtes.2017.32916. [PubMed: 29569689].
28. Kelkar R, Rajput DS. Functional outcome of orthogonal plating in treatment of distal humerus fracture. Int J Orthop Sci. 2018;4(2):278-83. doi: 10.22271/ortho.2018.v4.i2e.41.
29. Savvidou OD, Zampeli F, Koutsouradis P, Chloros GD, Kaspiris A, Sourmelis S, et al. Complications of open reduction and internal fixation of distal humerus fractures. EFORT Open Rev. 2018;3(10):558-67. doi: 10.1302/2058-5241.3.180009. [PubMed: 30662764]. [PubMed Central: PMC6335604].
30. Kapil Mani K, Acharya P, Dirgha Raj R, Sigdel A. Functional Outcomes of Type C Distal Humerus Fractures in Adults Fixed by Orthogonal Double Plating. Apollo Med. 2018;15(1):15-20. doi: 10.4103/am.am_18_17.
2. Ul Islam S, Glover AW, Waseem M. Challenges and Solutions in Management of Distal Humerus Fractures. Open Orthop J. 2017;11:1292-307. doi: 10.2174/1874325001711011292. [PubMed: 29290867]. [PubMed Central: PMC5721336].
3. Van Tunen B, Van Lieshout EMM, Mader K, Den Hartog D. Complications and range of motion of patients with an elbow dislocation treated with a hinged external fixator: a retrospective cohort study. Eur J Trauma Emerg Surg. 2022;48(6):4889-96. doi: 10.1007/s00068-022-02013-x. [PubMed: 35750865]. [PubMed Central: PMC9712317].
4. Reichert IL, Ganeshamoorthy S, Aggarwal S, Arya A, Sinha J. Dislocations of the elbow - An instructional review. J Clin Orthop Trauma. 2021;21:101484. doi: 10.1016/j.jcot.2021.101484. [PubMed: 34367909]. [PubMed Central: PMC8321949].
5. Patel J, Motwani G, Shah H, Daveshwar R. Outcome after internal fixation of intraarticular distal humerus (AO type B & C) fractures: Preliminary results with anatomical distal humerus LCP system. J Clin Orthop Trauma. 2017;8(1):63-7. doi: 10.1016/j.jcot.2017.02.004. [PubMed: PMC5359525]. [PubMed Central: PMC5359525].
6. Yadav V, Sharma P, Gohiya A. Functional outcome of intraarticular distal humerus fracture fixation using triceps- sparing paratricipital approach. Indian J Orthop. 2016;50(6):595-601. doi: 10.4103/0019-5413.193487. [PubMed: 27904213]. [PubMed Central: PMC5122253].
7. Lee H-J. Surgical treatment strategy for distal humerus intra- articular fractures. Clin Shoulder Elb. 2019;22(2):113-7. doi: 10.5397/cise.2019.22.2.113. [PubMed: 33330205]. [PubMed Central: PMC7714297].
8. Iselin LD, Mett T, Babst R, Jakob M, Rikli D. The triceps reflecting approach (Bryan-Morrey) for distal humerus fracture osteosynthesis. BMC Musculoskelet Disord. 2014;15:406. doi: 10.1186/1471-2474-15-406. [PubMed: 25471796]. [PubMed Central: PMC4289245].
9. Zhou SC, Jin SY, Wang QY, Ren GK, Peng CG, Wang YB, et al. Surgical flip-dislocation of the bicolumnar approach without olecranon osteotomy versus olecranon osteotomy in type AO 13C3 distal humeral fracture: a matched-cohort study. J Orthop Surg Res. 2023;18(1):913. doi: 10.1186/s13018-023-04405-0. [PubMed: 38031095]. [PubMed Central: PMC10688126].
10. Holte AJ, Dean RE, Chang G. Distal humerus fractures: review of literature, tips, and tricks. JSES Rev Rep Tech. 2023;4(3): 639-46. doi: 10.1016/j.xrrt.2023.11.004. [PubMed: 39157236]. [PubMed Central: PMC11329030].
11. Cummings JL, Schwabe MT, Rivera AE, Sanders J, Denning JR, Neal K, et al. K-wire Versus Screw Fixation in Displaced Lateral Condyle Fractures of the Humerus in Children: A Multicenter Study of 762 Fractures. J Pediatr Orthop. 2023;43(4):e284-e9. doi: 10.1097/bpo.0000000000002348. [PubMed: 36634213]. [PubMed Central: PMC11216759].
12. Jagadish U, Kumar KV, Shanthappa AH. Functional Outcome of Distal Humerus Fractures Treated With Open Reduction and Internal Fixation With Bicolumnar Plating in a Tertiary Care Setting. Cureus. 2023;15(1):e33540. doi: 10.7759/cureus.33540. [PubMed: 36779108]. [PubMed Central: PMC9907393].
13. Virani SR, Sonone S, Dahapute AA, Panda I, Roy KD. Functional Results of Communited Intra-articular Distal Humerus Fractures Treated with Bicolumnar Plating. J Clin Diagn Res. 2017;11(4):Rc01-rc3. doi:10.7860/jcdr/2017/20777.9666. [PubMed: 28571218]. [PubMed Central: PMC5449864].
14. Jayakumar P, Ring D. A Pitfall in Fixation of Distal Humeral Fractures with Pre-Contoured Locking Compression Plate. Arch Bone Jt Surg. 2015;3(2):130-3. [PubMed: 26110181]. [PubMed Central: PMC4468620].
15. Shih CA, Kuan FC, Hsu KL, Hong CK, Lin CL, Yeh ML, et al. Does posterior configuration have similar strength as parallel configuration for treating comminuted distal humerus fractures? A cadaveric biomechanical study. BMC Musculoskelet Disord. 2021;22(1):440. doi: 10.1186/s12891-021- 04302-9. [PubMed: 33990212]. [PubMed Central: PMC8122534].
16. Saini R, Sharma A, Rathore KS, Sidhu SS. Clinical and Functional Outcomes of Anatomical Plating in Distal Humerus Fractures in Adults. Cureus. 2023;15(2):e35581. doi: 10.7759/cureus.35581. [PubMed: 37007319]. [PubMed Central: PMC10062419].
17. Bahroun S, Grami H, Kacem MS, Aloui A, Jlalia Z, Daghfous MS. Comparative analysis of two double-plate fixation techniques for intercondylar fractures of the distal humerus. Sci Rep. 2024;14(1):23913. doi: 10.1038/s41598-024-73299-7. [PubMed: 39397058]. [PubMed Central: PMC11471842].
18. Athanaselis ED, Komnos G, Deligeorgis D, Hantes M, Karachalios T, Malizos KN, 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. doi: 10.5005/jp-journals-10080-1546. [PubMed: 35734034]. [PubMed Central: PMC9166263].
19. Papen A, Schöttker-Königer T, Schäfer A, Morrison F, Hollinger B, Burkhart KJ, et al. Reliability, validity and critical appraisal of the cross-cultural adapted German version of the Mayo Elbow Performance Score (MEPS-G). J Orthop Surg Res. 2022;17(1):328. doi: 10.1186/s13018-022-03210-5. [PubMed: 35752835]. [PubMed Central: PMC9233775].
20. Wilson ES, Buckwalter JAt, Henning G, Davison J, Fleury IG, Willey MC. Inclusion of Olecranon Osteotomy With the Posterior Approach for Fixation of Distal Humerus Fractures (OTA/AO 13) Does Not Increase Surgical Complications. J Orthop Trauma. 2021;35(7):e223-e7. doi: 10.1097/bot.0000000000002006. [PubMed: 33208714].
21. Jeong HS, Yang JY, Jeon SJ, Shon HC, Oh JK, Lim EJ. Comparison of olecranon osteotomy and paratricipital approach in distal humerus intra-articular fracture: A systematic review and meta-analysis. Medicine (Baltimore). 2022;101(34):e30216. doi: 10.1097/md.0000000000030289. [PubMed: 36042686]. [PubMed Central: PMC9410592].
22. Singh R, Kanodia N, Singh H. Outcome following olecranon osteotomy versus paratricipital approach for complex intra- articular (AO 13-C) fracture of distal humerus: a prospective comparative study. J Shoulder Elbow Surg. 2019;28(4):742-50. doi: 10.1016/j.jse.2019.01.002. [PubMed: 30885311].
23. Singh S, Arif M, Gupta S. Functional outcome of AO type C distal humerus fractures treated with internal fixation using olecranon osteotomy in a tertiary care hospital. Int J Res Med Sci. 2021;9(11):3298-301. doi: 10.18203/2320-6012.ijrms20214051.
24. ElmadagM,ErdilM,BilselK,AcarMA,TuncerN,TuncayI.The olecranon osteotomy provides better outcome than the triceps-lifting approach for the treatment of distal humerusfractures. Eur J Orthop Surg Traumatol. 2014;24(1):43-50. doi: 10.1007/s00590-012-1149-y. [PubMed: 23412273].
25. Park SG, Seok HG. Bi-columnar locking plate fixation through a
combined medial and lateral approach for the treatment of low transcondylar fractures of the distal humerus in the elderly. BMC Musculoskelet Disord. 2022;23(1):764. doi:10.1186/s12891-022- 05594-1. [PubMed: 35948886]. [PubMed Central: PMC9367132].
26. Chouhan S, Bhinde S, Shekhawat Y, Panwar N, Bajoria R. A prospective study of functional outcome in intra articular distal humerus fracture treated with dual plating. Int J Orthop Sci. 2018;4(2):51-5. doi: 10.22271/ortho.2018.v4.i2a.10.
27. Asfuroğlu ZM, İnan U, Ömeroğlu H. Open reduction and internal fixation in AO type C distal humeral fractures using olecranon osteotomy: Functional and clinical results. Ulus Travma Acil Cerrahi Derg. 2018;24(2):162-7. doi: 10.5505/tjtes.2017.32916. [PubMed: 29569689].
28. Kelkar R, Rajput DS. Functional outcome of orthogonal plating in treatment of distal humerus fracture. Int J Orthop Sci. 2018;4(2):278-83. doi: 10.22271/ortho.2018.v4.i2e.41.
29. Savvidou OD, Zampeli F, Koutsouradis P, Chloros GD, Kaspiris A, Sourmelis S, et al. Complications of open reduction and internal fixation of distal humerus fractures. EFORT Open Rev. 2018;3(10):558-67. doi: 10.1302/2058-5241.3.180009. [PubMed: 30662764]. [PubMed Central: PMC6335604].
30. Kapil Mani K, Acharya P, Dirgha Raj R, Sigdel A. Functional Outcomes of Type C Distal Humerus Fractures in Adults Fixed by Orthogonal Double Plating. Apollo Med. 2018;15(1):15-20. doi: 10.4103/am.am_18_17.
| Files | ||
| Issue | Vol 11 No 3 (2025) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v11i3.19405 | |
| Keywords | ||
| Distal Humeral Fractures Intra-Articular Fractures Elbow Joint | ||
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How to Cite
1.
Bhuktar V, Patel M, DasGupta B, Shinde M, Gowda K, Sarwey K, Jethliya S, Shah P, Zaveri A, Singh Y, Date M, Jain Y, Revankar S. Evaluation of the Functional Outcome in Intra-Articular Distal Humerus Fractures Treated by Dual Plating. J Orthop Spine Trauma. 2025;11(3):105-10.
