Abstract
Purpose: To review the functional outcome of AO type C distal humeral fractures (bicondylar
fractures) managed with dual orthogonal plate fixation. Method: Twenty-three patients were reviewed retrospectively at a mean of 45.1 months. Patient-rated
outcomes (Disabilities of the Arm Shoulder and Hand [DASH], Patient Rated Ulnar Nerve
Evaluation [PRUNE], American Shoulder and Elbow Surgeons Elbow form [ASES-e], and
Short Form-36 [SF-36]), clinical, radiographic, and objective evaluations were used
to assess outcomes. Results: Almost 40% of patients required a third plate for adequate fixation. Patients identified
minimal subjective deficits (10%) with a mean satisfaction of 93%. The arc of motion
was decreased in the flexion-extension plane (122° relative to 138°, p < .01), whereas
strength was lower for both elbow flexion-extension and forearm rotation (p < .05).
The overall complication rate was 48%, however, most were minor and resolved without
further surgery. No ulnar neuropathies were identified at follow-up after routine
ulnar nerve transposition. Conclusions: Outcomes of AO type C distal humeral fractures were good with dual orthogonal plating,
ulnar nerve transposition, and early motion. Additional plating may be required with
distal fracture patterns or osteopenic bone. (J Hand Surg 2003;28A:294-308. Copyright
© 2003 by the American Society for Surgery of the Hand.)
Keywords
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References
- Manual of Internal Fixation Techniques Recommended by the AO group.in: Ed. 2. Springer, New York1979: 176-177
- Supracondylar fractures of the humerus in adults.J Trauma. 1980; 20: 71-74
- Intraarticular fractures of the distal humerus in the adult.Clin Orthop. 1987; 216: 99-108
- Internal fixation of the distal humerus: a biomechanical comparison of methods.J Orthop Trauma. 1990; 4: 260-264
- Intercondylar fractures of the humerus.J Bone Joint Surg. 1985; 67A: 226-239
- Intercondylar fractures of the distal humerus: routine anterior subcutaneous transposition of the ulnar nerve in a posterior operative approach.J Trauma. 1994; 36: 770-773
- Bicondylar intraarticular fractures of the distal humerus in adults: their assessment, classification and operative management.Adv Orthop. 1985; 8: 223-235
- Comminuted intraarticular fractures of the distal humeral condyles. Surgical vs. nonsurgical treatment.Clin Orthop. 1986; 202: 197-204
- Operative management of intraarticular fractures of the distal humerus.J Orthop Trauma. 1987; 1: 24-35
- Supracondylar fractures of the humerus—results of surgical treatment.J Trauma. 1988; 28: 1615-1621
- Intraarticular fractures of the distal humerus. Surgical treatment and results.Clin Orthop. 1989; 241: 238-244
- Distal humeral fractures in the adult.Clin Orthop. 1986; 207: 191-197
- Surgical treatment of bicondylar fractures of the distal humerus.Injury. 1994; 25: 433-438
- Operative treatment of distal humeral fractures in the elderly.J Bone Joint Surg. 1994; 76B: 793-796
- Open reduction and internal fixation of the distal humerus: functional outcome in the elderly.J Trauma. 1997; 43: 578-584
- Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach.J Bone Joint Surg. 2000; 82A: 1701-1707
- Functional outcome after open supracondylar fractures of the humerus. The effect of the surgical approach.J Bone Joint Surg. 2000; 82B: 646-651
- Validity of observer-based aggregate scoring systems as descriptors of elbow pain, function, and disability.J Bone Joint Surg. 1998; 80A: 154-162
- Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand).Am J Ind Med. 1996; 29: 602-608
- The effect of comorbidity and duration of nonunion on outcome after surgical treatment for nonunion of the humerus.J Shoulder Elbow Surg. 1998; 7: 127-133
- Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses.J Bone Joint Surg. 1976; 58A: 453-458
- Development of a scale for patient rating of wrist pain and disability.J Hand Ther. 1996; 9: 178-183
- Patient rating of wrist pain and disability: a reliable and valid measurement tool.J Orthop Trauma. 1998; 12: 577-586
- Reliability of a patient-rated forearm evaluation questionnaire for patients with lateral epicondylitis.J Hand Ther. 1999; 12: 31-37
- Outcome evaluation in patients with elbow pathology: issues in instrument development and evaluation.J Hand Ther. 2001; 14: 105-114
- SF-36 Health Survey Manual and Interpretation Guide.New England Medical Centre, The Health Institute, Boston1993
- A standardized method for assessment of elbow function—research committee, American Shoulder and Elbow Surgeons.J Shoulder Elbow Surg. 1999; 8: 351-354
- Reliability of range-of-motion measurements in the elbow and forearm.J Shoulder Elbow Surg. 1998; 7: 573-580
- Reliability of the LIDO active isokinetic dynamometer concentric mode.Instr Res. 1992; 4: 191-194
- Test-retest reliability of static endurance grip strength tests performed on the Jamar and NK.Physiother Can. 2001; 53: 48-54
- Inter-instrument reliability of pinch strength measures.J Hand Ther. 2001; 14: 36-42
- Intraarticular fractures of the distal end of the radius in young adults.J Bone Joint Surg. 1986; 68A: 647-659
- The classification and treatment of heterotopic ossification about the elbow and forearm.Hand Clin. 1994; 10: 417-437
- Fractures de la palette humérale chez I'adulte: évaluation fonctionnelle et mesures de forces isométriques.Rev Chir Orthop. 1997; 83: 551-560
- A biomechanical study of normal elbow motion.J Bone Joint Surg. 1981; 72A: 601-618
- Elbow joint force predictions for some strenuous isometric actions.J Biomech. 1980; 8: 765-775
- Isometric elbow strength in normal individuals.Clin Orthop. 1987; 222: 261-266
- Reliability of isometric strength testing. Temporal factors and strength variation.Clin Orthop. 1984; 185: 301-305
- Extensive posterior exposure of the elbow. A triceps-sparing approach.Clin Orthop. 1982; 166: 188-192
- Outcome of plate fixation of olecranon fractures.J Orthop Trauma. 2001; 15: 542-548
- Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid.J Bone Joint Surg. 1985; 77A: 316-327
- Displaced olecranon fractures in adults. Biomechanical analysis of fixation methods.Clin Orthop. 1987; 224: 210-214
- Displaced olecranon fractures in adults. Clinical evaluation.Clin Orthop. 1987; 224: 215-223
- The complications of surgical treatment of displaced fractures of the olecranon.Injury. 1987; 18: 48-50
- Olecranon fractures. A clinical and radiographic comparison of tension band wiring and plate fixation.Clin Orthop. 1992; 285: 229-235
- Contoured LCDC plating of the proximal ulna.Injury. 1996; 27: 411-417
- Bicondylar intraarticular fractures of the distal humerus in adults.Clin Orthop. 1993; 292: 26-36
- AO principles of fracture management: humerus-distal.in: Thieme, New York2000: 317
- Complex fractures of the distal part of the humerus and associated complications.ICL. 1995; 44: 187-198
- The results of ulnar neurolysis for ulnar neuropathy during post-traumatic elbow reconstruction.Orthop Trans. 1995; 19: 162-163
- Fixation of complex elbow fractures, part 1. General overview and distal humerus-fractures.Hand Clin. 1997; 13: 703-719
- Complex fractures of the distal humerus and their complications.J Shoulder Elbow Surg. 1999; 8: 85-97
- Surgical treatment of distal intrarticular humeral fractures in adults.Int Orthop. 2001; 25: 46-50
- Intraarticular distal humerus fractures. Factors affecting functional outcome.Clin Orthop. 1996; 332: 200-208
- Myositis ossificans. Aftermath of elbow injuries.Clin Orthop. 1967; 50: 129-134
- Post-traumatic heterotopic ossification about the elbow.Orthopedics. 1998; 21: 265-268
- Functional evaluation of the elbow.in: The elbow and its disorders. WB Saunders, Philadelphia1985: 73-91
- 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: 48-52
- Fractures of the distal humerus: role of elbow replacement.Orthop Clin North Am. 2000; 31: 145-154
- Complex fractures of the distal humerus in the elderly. The role of total elbow replacement as primary treatment.J Bone Joint Surg. 2002; 84B: 812-816
- Total elbow replacement for complex fractures of the distal humerus. An option for the elderly patient.J Bone Joint Surg. 2001; 83B: 974-978
Article info
Publication history
Accepted:
November 21,
2002
Received in revised form:
November 21,
2002
Received:
February 25,
2002
Footnotes
☆No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
☆☆Reprint requests: Graham J. W. King, MD, HULC, St. Joseph's Hospital, 268 Grosvenor St, London, Ontario, N6A 4L6 Canada.
★0363-5023/03/28A02-0018$30.00/0
Identification
Copyright
© 2003 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
