Evaluation of Outcomes of Open Reduction and Internal Fixation Surgery in Patients with Type C Distal Humeral Fractures

Nouraei, Mohammadhadi; Motififar, Mehdi; Barazandeh, Morteza

Evaluation of Outcomes of Open Reduction and Internal Fixation Surgery in Patients with Type C Distal Humeral Fractures

Document Type : Original Article

Authors

Department of Orthopedics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: In this study, functional state of patients with Type C distal humerus fractures undergone surgical plating was evaluated 6 and 12 months after the surgery in order to record postsurgical factors such as pain level and job/performance satisfaction. Materials and Methods: In this cross-sectional study, 46 patients with humerus fractures were recruited and their ability to do daily tasks, presence of degenerative changes, stability of elbow joint, and range of motion was evaluated. For assessment of response to surgery, Mayo score was used. Results: Among 46 patients, 45 (97.8%) of them had joint stability. Evaluation of postsurgical complications showed that six subjects (13%) had no complications, but superficial infection was observed in 12 (26.1%) subjects. Neuromuscular disorders in ulnar nerve were present in 11 subjects (23.9%), recurrent articular bursitis of elbow joint in 6 subjects (13%), stiffness of elbow joint in 29 subjects (63%), nonunion of fracture in 3 subjects (6.5%), and myositis ossification in 4 (8.7%) subjects. Furthermore, 18 (39.1%) patients presented with more than one (2–4) complications. Conclusion: Open reduction and internal fixation surgery with dual plating is the method of choice for treatment of Type C distal humeral fractures. Evaluation of long-term outcomes of this surgery could be done via several different questionnaires as many studies suggest. This study demonstrated that the outcomes of this surgery in Isfahan, Iran, have been noticeably inferior compared to results of the studies in other parts of the world.

Highlights

1.	Gofton WT, Macdermid JC, Patterson SD, Faber KJ, King GJ. Functional outcome of AO type C distal humeral fractures. J Hand Surg Am 2003;28:294-308. [PUBMED]
2.	Müller ME, Allgöwer M. Manual of internal fixation: Techniques recommended by the AO-ASIF group. New York: Springer; 1979.
3.	Horne G. Supracondylar fractures of the humerus in adults. J Trauma 1980;20:71-4. [PUBMED]
4.	Gabel GT, Hanson G, Bennett JB, Noble PC, Tullos HS. Intraarticular fractures of the distal humerus in the adult. Clin Orthop Relat Res 1987;216:99-108.
5.	Helfet DL, Hotchkiss RN. Internal fixation of the distal humerus: A biomechanical comparison of methods. J Orthop Trauma 1990;4:260-4. [PUBMED]
6.	Letsch R, Schmit-Neuerburg KP, Stürmer KM, Walz M. Intraarticular fractures of the distal humerus. Surgical treatment and results. Clin Orthop Relat Res 1989;241:238-44.
7.	Waddell JP, Hatch J, Richards R. Supracondylar fractures of the humerus – Results of surgical treatment. J Trauma 1988;28:1615-21. [PUBMED]
8.	Streiner DL, Norman GR, Cairney J. Health measurement scales: a practical guide to their development and use. Oxford University Press, USA; 2015.
9.	Kirshner B, Guyatt G. A methodological framework for assessing health indices. J Chronic Dis 1985;38:27-36. [PUBMED]
10.	Stratton Hill C. Guidelines for Treatment of Cancer Pain: The Revised Pocket Edition of the Final Report of the Texas Cancer Council's Workgroup on Pain Control in Cancer Patients,; pages Copyright 2003, Texas Cancer Council. Reprinted with permission.. p. 65.
11.	Pajarinen J, Björkenheim JM. 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.
12.	Puchwein P, Wildburger R, Archan S, Guschl M, Tanzer K, Gumpert R. Outcome of type C (AO) distal humeral fractures: Follow-up of 22 patients with bicolumnar plating osteosynthesis. J Shoulder Elbow Surg 2011;20:631-6. [PUBMED]
13.	Krishnamurthy M. Evaluation and outcome of surgical management of supracondylar fracture humerus with intercondylar extension in adults. Sch J App Med Sci 2014;2(6F):3274-3280.
14.	Schmidt-Horlohé K, Bonk A, Wilde P, Becker L, Hoffmann R. Functional results after osteosynthesis of the distal humerus fracture with an anatomically precontoured, angular-stable double plate system. Z Orthop Unfall 2010;148:300-8.
15.	Reising K, Hauschild O, Strohm PC, Suedkamp NP. Stabilisation of articular fractures of the distal humerus: Early experience with a novel perpendicular plate system. Injury 2009;40:611-7. [PUBMED]
16.	Rüedi TP, Murphy WM. AO principles of fracture management. Davos: AO Publishing and Stuttgart New York: Georg Thieme Verlag. 2007.
17.	Kundel K, Braun W, Wieberneit J, Rüter A. Intraarticular distal humerus fractures. Factors affecting functional outcome. Clin Orthop Relat Res 1996;322:200-8.

Keywords

Advanced Biomedical Research