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Fixation of Supracondylar Intercondylar Fracture Humerus by Anatomical Distal Humerus Plates

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Fixation of Supracondylar Intercondylar Fracture Humerus by Anatomical Distal Humerus Plates Fixation of Supracondylar Intercondylar Fracture Humerus, Al-Gioshy, Safwat and Mohammed MD. 1 Fixation of Supracondylar Intercondylar Fracture Humerus by Anatomical Distal Humerus Plates Ali Mohammed Al-Gioshy M.D.(1), Hisham Mohammed Safwat M.D.(2), and Al-Moatasem Bellah Mohammed (3) (1) Professor at Department of Orthopaedic Abstract Surgery, Al-Azhar Faculty of Medicine, Cairo (2) Professor at Department of Orthopaedic Surgery, Al-Azhar Faculty of Medicine, Cairo Background (3) Resident Doctor at Department of Orthopaedic Fractures of the distal humerus have traditionally been a significant challenge to be treated for Surgery, Al-Azhar Faculty of Medicine, Cairo the orthopedic surgeons. The anatomical complexity, limited bone stock of the distal segment, frequent fracture commination, and the close proximity of neurovascular structures add to the Corresponding Author: Al-Moatasem Bellah Mohammed difficulty of fracture treatment. The locking compression plate and distal humerus plate (LCP- Address: Al Hussein Hospital, Al-Azhar DHP) system produces high-quality reconstructions and sufficient stability, thereby enabling University, Cairo Governorate, Egypt early mobilization for distal humerus fractures. Tel: 0553650795 Objective Mob: 01093445108 The aim of this study is to evaluate fixation of supracondylar intercondylar humerul fractures E-mail: [email protected] by anatomical distal humeral plates. Functional results will be assessed with Mayo elbow per- formance (MEP) scores. Materials and Methods A prospective study of 20 patients with supracondylar intercondylar humeral fractures was treated by anatomical distal humeral plates in the department of Orthopaedics at Al-Azhar university hospitals between the period of October 2016 till September 2017. Variables of each patient were recorded The Egyptian Orthopedic Journal; 2019 and analyzed with respect to age, sex, fracture type, mode of injury, limb involvement, associated supplement (2), December, 54: 1-7 injuries, follow up, complications and final outcomes. These patients were followed up at different intervals i.e. at every week for first 1 months, then interval of 1 month for next 6 months and then at 3-month interval. Results As regard 20 patents in this study, the result of our study showed 8 cases (40%) had excellent result, 8 cases (40%) had good result, and 4 cases (20%) had poor result. The Mean ±SD of score was 83.5 ± 17.6. Conclusion Locked compression plates have been popularized that utilize fixed angle screws that are be- lieved to provide superior fixation. They have an additional advantage of neocortical screw placement that avoids risk of screw tips projecting into the joints. These locked compression plates and distal humerus plates are more useful in patients with osteoporotic bones, metaphy- seal commination and very low type of intra-articular fractures. Keywords Supracondylar Intercondylar Fracture Humerus - Anatomical Distal Humerus Plates. Introduction years and older, characteristically in females.[2] Fractures of the distal humerus have traditionally Humeral intercondylar fractures are often caused by been a significant challenge to be treated for the or- the impact of the trochlear notch of the ulna, leading thopedic surgeons. The anatomical complexity, lim- to the separation and dislocation of the bilateral ited bone stock of the distal segment, frequent frac- condyles. [3] ture commination, and the close proximity of neurovascular structures add to the difficulty of frac- The locking compression plate and distal humerus ture treatment. [1] plate (LCP-DHP) system produces high-quality re- constructions and sufficient stability, thereby enabling Distal humerus fractures comprise approximately 2% early mobilization for distal humerus fractures. [4] of all fractures. They have a bimodal age distribution, This technique has been shown to achieve satisfactory with peak incidences occurring between the ages of function of the elbow joint and high rate of union. [5] 12 and 19 years, usually in males, and those aged 80 Egyptian Orthopedic Journal, Vol. 54 (supplement 2), December 2019 2 Egyptian Orthopedic Journal While recent advances in implant design, surgical Anatomical DHP have several advantages. approach, and fixation techniques lead to good func- Posterolateral and medial plates allow implant tional outcomes, distal humerus fractures are still as- placement to address the individual fracture pattern. sociated with several complications. These complica- Plates are precontoured for anatomical fit. tions include loss of reduction, implant failure, non- Posterolateral plate with lateral support offers the union, malunion, ulnar nerve neuropathy, elbow stiff- option for two additional screws placed lateral to ness, and heterotopic ossification. [1] medial. Monocortical fixation is sufficient since the diverging nature of the screws in the locked holes The majority of distal humerus fractures occur in one ensures good construct stability. Posterolateral plates of two ways, low energy falls or high energy trauma. offer fixation of the capitulum with three distal [6] screws. Five options for screwing into the distal block permit the fixation of extremely distal fractures, High-energy injuries are the cause of most distal hu- especially in osteoporotic bone as the screws are also merus fractures in younger adults. Motor vehicle col- locked into the plate. The two-plate construct creates lisions, sports, falls from height, and industrial acci- a girder-like structure which strengthens the fixation. dents predominate. [2] The posterolateral plate functions as a tension band Riseborough & Radin Classify the as four types. The during elbow flexion, and the medial plate supports fragments can be in place, displaced, rotated or com- the medial side of the distal humerus. Orthogonal minuted. [7] Jupiter Classification of I.C.Humerus Frac- plates have high stiffness and strength relative to ture was high-T, low-T, Y, H, medial lambda, lateral other constructs for the various movements (flexion, lambda and multiplane T. [8] AO/The Orthopedic extension, rotation). LCPs can also be used as a Trauma Association’s classification Assigned three neutralization plate, resorting to shorter plate and one main types of distal humerus fracture. Type A: extra- less screw per fragment. [12, 13] articular (supracondylar fracture) 80% extension type. Type B: Intraarticular- single column (partial articular). Type C: intraarticular- both columns fractured and no Patients and Methods portion of the joint contiguous with the shaft (complete articular). [9] From October 2016 to October 2017 a prospective study was undergone at Alazhar university hospitals Conservative treatment is accepted in the elderly be- (Al-Hussein and Sayed Galal hospitals), Cairo, Egypt fore arthrolysis and arthroplasty. [10] and in cases of on patients with supracondylar intercondylar fracture hemiplegia sequelae involving the ipsilateral upper humerus treated by ORIF with anatomical distal hu- limb advanced osteoporosis and Fractures with exten- meral plates. sive bone loss, but the functional result will always be unsatisfactory.[11] Patients with nondisplaced frac- The inclusion criteria included mature skeleton, re- tures may also be managed with a trial of nonopera- cent supracondylar intercondylar fracture humerus tive management. [2] and 4 months post-operative follow up. Surgical fixation of these fractures enhances stability, The exclusion criteria include skeletally immature allows immediate motion and obviously decreases the patients, neglected fracture humerus, concomitant risk of delayed fracture displacement. Common neurovascular injury, previous elbow surgery, loss of method of fixation is perpendicular and parallel follow-up, pre-existing deformity, disability, infection plates. [2] and Unfit patient for surgery. Arthroplasty is the most reasonable option for elderly According to age of patients, 70% of patients were patients with unrepairable distal humerus fractures. adults of 73.3 ± 5.1 years while 30% were old age of [2] There are common approaches for surgical expo- 35±10.3 years. sure of I.C. fracture humerus include Classic ole- cranon osteotomy (At bare area of sigmoid notch), According to sex distribution in all studied cases, Triceps anconeus sparing approach (TRAP), Bryan there were 30% males and 70% females. &Morrey approach, Triceps splitting approach and Triceps tongue reflecting approach. Complications of According to the affected side in all studied cases, I.C. Fracture Humerus include Ulnar nerve injury, there were 50 % Rt. sided affected and 50 % Lt. sided Elbow stiffness and Contracture, Delayed union and affected. Nonunion, Heterotopic Ossification (HO), Malunion, According to mode of fracture, fall on elbow accounts Infection (superficial or deep) and Myositis ossifi- for about 40% while road traffic accident accounts for cans. 60% of studied cases (Table- 1). 2 Fixation of Supracondylar Intercondylar Fracture Humerus, Al-Gioshy, Safwat and Mohammed MD. 3 Classification of fracture in studied patients was cases showed isolated fracture while 20% of cases C1:40%, C2: 20% and C3: 40% (Table- 2). 80% of showed associated other fractures. Table (1): Showing Cause of Injury Cause of Injury No. of Patient (N=30) Percentage Fall 8 40 RTA 12 60 Table (2): Showing Types of Fracture (AO Classification) Type of fracture No. of cases (N = 30) Percentage C1 8 40 C2 4 20 C3 8 40 Operative and Surgical Technique limb immobilized in above elbow slab with elbow in
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