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Precontoured parallel plate fixation of AO/OTA type C distal humerus fractures
George S Athwal1, Samuel C Hoxie, Damian M Rispoli
1Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario N6A 4L6, Canada. gathwal@uwo.ca
Insights
Precontoured parallel plating effectively treats Orthopaedic Trauma Association (OTA) type C distal humerus fractures. However, surgeons must remain vigilant due to a high complication rate, including nerve injuries.
Area of Science:
- Orthopaedic surgery
- Trauma management
- Skeletal fixation
Background:
- Distal humerus fractures, specifically Orthopaedic Trauma Association (OTA) type C, present complex management challenges.
- Effective surgical fixation is crucial for restoring elbow function and preventing long-term disability.
Purpose of the Study:
- To evaluate the clinical effectiveness of precontoured parallel plating for OTA type C distal humerus fractures.
- To assess functional outcomes, complication rates, and radiographic healing following this surgical technique.
Main Methods:
- Retrospective case series conducted at a Level I trauma center.
- Thirty-two patients with OTA type C distal humerus fractures underwent open reduction and internal fixation using the Mayo Elbow Congruent Plating system.
- Outcomes measured included range of motion, Mayo Elbow Performance Score, Disabilities of the Arm, Shoulder and Hand (DASH) score, complications, and radiographic evaluation.
Main Results:
- At a mean 27-month follow-up, patients achieved a mean elbow motion arc of 97 degrees.
- The mean Mayo Elbow Performance Score was 82, and the mean DASH score was 24.
- No implant failures occurred, and all fractures healed; however, 53% of patients experienced complications, including 16% with postoperative nerve injuries.
Conclusions:
- Precontoured parallel plating is an effective treatment for OTA type C distal humerus fractures, facilitating fracture healing and functional recovery.
- The high complication rate necessitates meticulous surgical technique and thorough patient counseling regarding potential risks, particularly nerve injuries.
Objectives:
To determine the clinical effectiveness of precontoured parallel plating for the management of Orthopaedic Trauma Association (OTA) type C distal humerus fractures.
Design:
Retrospective case series.
Setting:
Level I trauma center.
Patients/Participants:
Between 2001 and 2005, 37 patients with OTA type C distal humerus fractures underwent open reduction and internal fixation exclusively with the Mayo Elbow Congruent Plating system. Thirty-two patients consented to participate in the study.
Intervention:
All patients underwent open reduction and internal fixation with a precontoured bicolumn parallel plating system.
Main Outcome Measurements:
Range of motion, Mayo Elbow Performance Score, Disabilities of the Arm, Shoulder and Hand score (DASH), complication rate, and radiographic evaluation.
Results:
At a mean of 27 months follow up, the mean arc of elbow flexion-extension motion was 97 degrees (range, 10 degrees -145 degrees ). The mean Mayo Elbow Performance Score was 82 points and the mean DASH score was 24 points. There were no implant failures and all distal humerus fractures healed. A total of 24 complications occurred in 17 patients (53%) with five patients (16%) having postoperative nerve injuries.
Conclusions:
Open reduction and internal fixation with a precontoured parallel plating system is an effective treatment method for OTA type C distal humerus fractures. Despite this, the fact that over half of the patients had a significant complication will require utmost vigilance on the part of the surgeon to avoid intraoperative complications. Patient counseling is paramount.
