Abstract

Background

The purpose of this study was to identify complications after operative treatment of distal humerus fractures with anatomic, pre-contoured, locking distal humeral plates. We hypothesized that these fractures have high complication rates despite the use of these modern implants.

Materials and Methods

Between 2010 and 2018, 43 adult patients with a distal humerus fracture underwent open reduction and internal fixation (ORIF) at a Level I trauma center. Pre-operative variables, including medical comorbidities, mechanism of injury, open or closed fracture, AO/OTA fracture classification (Type A, B, or C), and nerve palsy, were recorded. Intra-operative variables including surgical approach, ulnar nerve transposition, and plate configuration were recorded. Anatomic, pre-contoured, locking distal humeral plates were used in all patients. Various plating systems were used based on surgeon preference and fracture pattern. Post-operative complications including infection, nonunion, malunion, painful implants, nerve palsy, heterotopic ossification, stiffness, and post-traumatic arthritis were recorded.

Results

Most fractures were Type C (53%). The posterior olecranon osteotomy approach (51%) and parallel plate configuration (42%) were used in most cases. At a mean follow-up of 15 months, the complication rate was 61% (26/43 patients). Among all patients, 49% (21/43 patients) required a reoperation. Elbow stiffness (19%) was the most common complication followed by nerve palsy (16%). There were four fracture nonunions (9%), deep infections (9%), painful implants (9%), post-traumatic arthritis (9%), and heterotopic ossification (9%).

Conclusions

Distal humerus fractures treated with ORIF utilizing anatomic, pre-contoured, locking distal humeral plates have a high complication rate, with many requiring reoperation.

Level of Evidence

Therapeutic Level IV.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

39,95 €

Price includes VAT (Vietnam)













References

  1. Robinson, C. M., Hill, R. M., Jacobs, N., Dall, G., & Court-brown, C. M. (2003). Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. Journal of Orthopaedic Trauma, 17(1), 38–47.

  2. Varecka, T. F., & Myeroff, C. (2017). Distal Humerus Fractures in the Elderly Population. Journal of American Academy of Orthopaedic Surgeons, 25(10), 673–683.

  3. Kundel, K., Braun, W., Wieberneit, J., & Rüter, A. (1996). Intraarticular distal humerus fractures. Factors affecting functional outcome. Clinical Orthopaedics and Related Research, 332, 200–208.

  4. Jupiter, J. B., Neff, U., Holzach, P., & Allgöwer, M. (1985). Intercondylar fractures of the humerus. An operative approach. The Journal of Bone and Joint surgery. American Volume, 67(2), 226–239.

  5. Pereles, T. R., Koval, K. J., Gallagher, M., & Rosen, H. (1997). Open reduction and internal fixation of the distal humerus: functional outcome in the elderly. Journal of Trauma, 43(4), 578–584.

  6. Obert, L., Ferrier, M., Jacquot, A., et al. (2013). Distal humerus fractures in patients over 65: complications. Orthopaedics and Traumatology: Surgery and Research, 99(8), 909–913.

  7. Claessen, F. M., Braun, Y., Peters, R. M., Kolovich, G. P., & Ring, D. (2015). Plate and screw fixation of bicolumnar distal humerus fractures: factors associated with loosening or breakage of implants or nonunion. The Journal of Hand Surgery, 40(10), 2045–2051.e2.

  8. Zagorski, J. B., Jennings, J. J., Burkhalter, W. E., & Uribe, J. W. (1986). Comminuted intraarticular fractures of the distal humeral condyles. Surgical vs. nonsurgical treatment. Clinical Orthopaedics and Related Research, 202, 197–204.

  9. Reising, K., Hauschild, O., Strohm, P. C., & Suedkamp, N. P. (2009). Stabilisation of articular fractures of the distal humerus: early experience with a novel perpendicular plate system. Injury, 40(6), 611–617.

  10. Gabel, G. T., Hanson, G., Bennett, J. B., Noble, P. C., & Tullos, H. S. (1987). Intraarticular fractures of the distal humerus in the adult. Clinical Orthopaedics and Related Research, 216, 99–108.

  11. Letsch, R., Schmit-neuerburg, K. P., Stürmer, K. M., & Walz, M. (1989). Intraarticular fractures of the distal humerus. Surgical treatment and results. Clinical Orthopaedics and Related Research, 241, 238–244.

  12. Tyllianakis, M., Panagopoulos, A., Papadopoulos, A. X., Kaisidis, A., & Zouboulis, P. (2004). Functional evaluation of comminuted intra-articular fractures of the distal humerus (AO type C). Long term results in twenty-six patients. Acta Orthopaedica Belgica, 70(2), 123–130.

  13. Gofton, W. T., Macdermid, J. C., Patterson, S. D., Faber, K. J., & King, G. J. (2003). Functional outcome of AO type C distal humeral fractures. The Journal of Hand Surgery, 28(2), 294–308.

  14. Pajarinen, J., & Björkenheim, J. M. (2002). 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. Journal of Shoulder and Elbow Surgery, 11(1), 48–52.

  15. Gupta, R., & Khanchandani, P. (2002). Intercondylar fractures of the distal humerus in adults: a critical analysis of 55 cases. Injury, 33(6), 511–515.

  16. Athwal, G. S., Hoxie, S. C., Rispoli, D. M., & Steinmann, S. P. (2009). Precontoured parallel plate fixation of AO/OTA type C distal humerus fractures. Journal of Orthopaedic Trauma, 23(8), 575–580.

  17. Greiner, S., Haas, N. P., & Bail, H. J. (2008). Outcome after open reduction and angular stable internal fixation for supra-intercondylar fractures of the distal humerus: preliminary results with the LCP distal humerus system. Archives of Orthopaedic and Trauma Surgery, 128(7), 723–729.

  18. Saragaglia, D., Rouchy, R. C., & Mercier, N. (2013). Fractures of the distal humerus operated on using the Lambda® plate: report of 75 cases at 9.5 years follow-up. Orthopaedics and Traumatology: Surgery and Research., 99(6), 707–712.

  19. Schmidt-horlohé, K. H., Bonk, A., Wilde, P., Becker, L., & Hoffmann, R. (2013). Promising results after the treatment of simple and complex distal humerus type C fractures by angular-stable double-plate osteosynthesis. Orthopaedics and Traumatology: Surgery and Research, 99(5), 531–541.

  20. Ring, D., & Jupiter, J. B. (1999). Complex fractures of the distal humerus and their complications. Journal of Shoulder and Elbow Surgery, 8(1), 85–97.

  21. Henley, M. B., Bone, L. B., & Parker, B. (1987). Operative management of intra-articular fractures of the distal humerus. Journal of Orthopaedic Trauma, 1(1), 24–35.

  22. Huang, T. L., Chiu, F. Y., Chuang, T. Y., & Chen, T. H. (2005). The results of open reduction and internal fixation in elderly patients with severe fractures of the distal humerus: a critical analysis of the results. Journal of Trauma, 58(1), 62–69.

  23. Erpelding, J. M., Mailander, A., High, R., Mormino, M. A., & Fehringer, E. V. (2012). Outcomes following distal humeral fracture fixation with an extensor mechanism-on approach. Journal of Bone and Joint Surgery. American Volume, 94(6), 548–553.

  24. Liu, J. J., Ruan, H. J., Wang, J. G., Fan, C. Y., & Zeng, B. F. (2009). Double-column fixation for type C fractures of the distal humerus in the elderly. Journal of Shoulder and Elbow Surgery, 18(4), 646–651.

  25. Luegmair, M., Timofiev, E., & Chirpaz-cerbat, J. M. (2008). Surgical treatment of AO type C distal humeral fractures: internal fixation with a Y-shaped reconstruction (Lambda) plate. Journal of Shoulder and Elbow Surgery, 17(1), 113–120.

  26. Simone, J. P., Streubel, P. N., Sanchez-sotelo, J., & Morrey, B. F. (2014). Low transcondylar fractures of the distal humerus: results of open reduction and internal fixation. Journal of Shoulder and Elbow Surgery, 23(4), 573–578.

  27. Doornberg JN, Van duijn PJ, Linzel D, et al. (2007). Surgical treatment of intra-articular fractures of the distal part of the humerus Functional outcome after twelve to thirty years. Journal of Bone and Joint Surgery. American Volume, 89(7), 1524–1532.

  28. Aslam, N., & Willett, K. (2004). Functional outcome following internal fixation of intraarticular fractures of the distal humerus (AO type C). Acta Orthopaedica Belgica, 70(2), 118–122.

  29. Kaiser, T., Brunner, A., Hohendorff, B., Ulmar, B., & Babst, R. (2011). Treatment of supra- and intra-articular fractures of the distal humerus with the LCP Distal Humerus Plate: a 2-year follow-up. Journal of Shoulder and Elbow Surgery, 20(2), 206–212.

  30. Muzaffar, N., Bhat, K., Ahmad, R., Wani, R., & Dar, M. (2014). Functional results after osteosynthesis of distal humeral fractures with pre-contoured LCP system. Ortopedia, Traumatologia, Rehabilitacja, 16(4), 381–385.

  31. Mckee, M. D., Wilson, T. L., Winston, L., Schemitsch, E. H., & Richards, R. R. (2000). Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach. Journal of Bone and Joint Surgery. American Volume, 82-A(12), 1701–1707.

  32. Soon, J. L., Chan, B. K., & Low, C. O. (2004). Surgical fixation of intra-articular fractures of the distal humerus in adults. Injury, 35(1), 44–54.

  33. Helfet, D. L., & Schmeling, G. J. (1993). Bicondylar intraarticular fractures of the distal humerus in adults. Clinical Orthopaedics and Related Research, 292, 26–36.

  34. Clavert, P., Ducrot, G., Sirveaux, F., Fabre, T., & Mansat, P. (2013). Outcomes of distal humerus fractures in patients above 65 years of age treated by plate fixation. Orthopaedics and Traumatology: Surgery and Research, 99(7), 771–777.

  35. John, H., Rosso, R., Neff, U., Bodoky, A., Regazzoni, P., & Harder, F. (1994). Operative treatment of distal humeral fractures in the elderly. Journal of Bone and Joint Surgery. British Volume, 76(5), 793–796.

  36. Muller, M. E. (1991). The comprehensive classification of fractures of long bones. In M. E. Muller, M. Allgower, R. Schneider, et al. (Eds.), Manual of internal fixation (3rd ed., pp. 118–150). Berlin: Springer-Verlag.

  37. O’driscoll, S. W. (2005). Optimizing stability in distal humeral fracture fixation. Journal of Shoulder and Elbow Surgery, 14(1 Suppl S), 186S–194S.

  38. Hastings, H., & Graham, T. J. (1994). The classification and treatment of heterotopic ossification about the elbow and forearm. Hand Clinics, 10(3), 417–437.

  39. Viola, R. W., & Hastings, H. (2000). Treatment of ectopic ossification about the elbow. Clinical Orthopaedics and Related Research, 370, 65–86.

  40. Morrey, B. F., Askew, L. J., & Chao, E. Y. (1981). A biomechanical study of normal functional elbow motion. Journal of Bone and Joint Surgery. American Volume, 63(6), 872–877.

  41. Riseborough, E. J., & Radin, E. L. (1969). Intercondylar T fractures of the humerus in the adult. A comparison of operative and non-operative treatment in twenty-nine cases. Journal of Bone and Joint Surgery. American Volume, 51(1), 130–141.

  42. Sardelli, M., Tashjian, R. Z., & Macwilliams, B. A. (2011). Functional elbow range of motion for contemporary tasks. Journal of Bone and Joint Surgery. American Volume, 93(5), 471–477.

  43. Park, M. J., Chang, M. J., Lee, Y. B., & Kang, H. J. (2010). Surgical release for posttraumatic loss of elbow flexion. Journal of Bone and Joint Surgery. American Volume, 92(16), 2692–2699.

  44. Galano, G. J., Ahmad, C. S., & Levine, W. N. (2010). Current treatment strategies for bicolumnar distal humerus fractures. Journal of American Academy of Orthopaedic Surgeons, 18(1), 20–30.

  45. Koh, K. H., Lim, T. K., Lee, H. I., & Park, M. J. (2013). Surgical release of elbow stiffness after internal fixation of intercondylar fracture of the distal humerus. Journal of Shoulder and Elbow Surgery, 22(2), 268–274.

  46. Vazquez, O., Rutgers, M., Ring, D. C., Walsh, M., & Egol, K. A. (2010). Fate of the ulnar nerve after operative fixation of distal humerus fractures. Journal of Orthopaedic Trauma, 24(7), 395–399.

  47. Chen, R. C., Harris, D. J., Leduc, S., Borrelli, J. J., Tornetta, P., & Ricci, W. M. (2010). Is ulnar nerve transposition beneficial during open reduction internal fixation of distal humerus fractures? Journal of Orthopaedic Trauma, 24(7), 391–394.

  48. Ilahi, O. A., Strausser, D. W., & Gabel, G. T. (1998). Post-traumatic heterotopic ossification about the elbow. Orthopedics., 21(3), 265–268.

  49. Foruria, A. M., Lawrence, T. M., Augustin, S., Morrey, B. F., & Sanchez-sotelo, J. (2014). Heterotopic ossification after surgery for distal humeral fractures. The Bone and Joint Journal, 96-B(12), 1681–1687.

  50. Abrams, G. D., Bellino, M. J., & Cheung, E. V. (2012). Risk factors for development of heterotopic ossification of the elbow after fracture fixation. Journal of Shoulder and Elbow Surgery, 21(11), 1550–1554.

Funding

None.

Ethics declarations

Conflict of interest

Dr. Hassan Mir has the following disclosures: AAOS Council on Advocacy: Board or committee member, AAOS Diversity Advisory Board: Board or committee member, AAOS Healthcare Systems Committee: Board or committee member, AO Trauma North America: Research support, AOA Leadership/Fellowship Committee: Board or committee member, Core Orthopaedics: Stock or stock Options, FOT Research Committee: Board or committee member, JAAOS Consultant Reviewer: Editorial or governing board, JBJS Consultant Reviewer: Editorial or governing board, Journal of Orthopaedic Trauma Associate Editor: Editorial or governing board, OrthoGrid: Stock or stock Options, OsteoSynthesis, The JOT Online Discussion Forum Editor: Editorial or governing board, OTA Education Committee: Board or committee member, OTA International Digital Editor: Editorial or governing board, Smith & Nephew: Paid consultant; Research support, Trice Medical: Paid consultant, Zimmer: Paid consultant. Dr. Jason Nydick has the following disclosures: Axogen: Paid consultant; Paid presenter or speaker, Checkpoint surgical: Paid presenter or speaker, DePuy, A Johnson & Johnson Company: Paid consultant; Paid presenter or speaker, Journal of Hand Surgery—American: Editorial or governing board, Mission Surgical: Paid consultant, Trimed: Paid consultant. Shaan Patel, Evan Horowitz, Carson Smith, Adil Ahmed, and Katheryne Downes do not have any disclosures. All authors contributed to the conception and design of the study, data analysis, manuscript writing, and editing.

Ethical standard statement

The authors certify that they have obtained all appropriate patient consent forms.

Informed consent

For this type of study informed consent is not required.

Rights and permissions

About this article

Cite this article

Patel, S.S., Mir, H.R., Horowitz, E. et al. ORIF of Distal Humerus Fractures with Modern Pre-contoured Implants is Still Associated with a High Rate of Complications. JOIO 54, 570–579 (2020). https://doi.org/10.1007/s43465-020-00124-4

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43465-020-00124-4

Keywords

  • Distal humerus fracture
  • Open reduction internal fixation
  • Complication

You are watching: ORIF of Distal Humerus Fractures with Modern Pre-contoured Implants is Still Associated with a High Rate of Complications. Info created by GBee English Center selection and synthesis along with other related topics.