Functional Outcomes of Extra-Articular Distal Humerus Fractures Managed With Anatomical Locking Plates: A Prospective...

Introduction Extra-articular distal humerus fractures account for approximately 16% of humerus fractures and 3% of adult fractures. These injuries present treatment challenges due to their periarticular location, frequent comminution, and often osteoporotic bone quality in elderly patients. Current management remains controversial between conservative immobilization and surgical fixation. The purpose of this study was to evaluate the functional outcomes of extra-articular distal end humerus fractures treated with open reduction and internal fixation (ORIF) with anatomical locking plates via the paratricipital approach. Methods We conducted a prospective study of 30 adults with AO Foundation/Orthopaedic Trauma Association (AO/OTA) type 13-A2/A3 fractures treated at our institution between October 2022 and October 2024. All patients underwent ORIF using anatomical locking plates via the paratricipital approach. Outcomes were assessed using the Mayo Elbow Performance Score (MEPS), range of motion measurements, and radiographic evaluation over 12 months of follow-up. Ethical clearance and informed consent were obtained for all procedures. Results At the 1-year follow-up, 76.6% of patients achieved good-to-excellent MEPS scores, with a mean score of 81. The MEPS showed statistically significant improvement from a mean of 61.3 at one month to 81.0 at 12 months (p<0.001). The mean elbow flexion was 110.8°, with an extension deficit of 8.2°, and a mean supination/pronation of 67.1°. All fractures achieved radiographic union by an average of 12.4 weeks. Complications included transient radial nerve palsy in two patients (6.7%), superficial infection in one patient (3.3%), and implant failure in one patient (3.3%). Conclusion ORIF using anatomical LCP via the paratricipital approach provides stable fixation, facilitates early mobilization, with excellent functional outcomes for extra-articular distal humerus fractures, with minimal complications. This technique is particularly advantageous for preserving the radial nerve and addressing osteoporotic bone. Further comparative studies with longer follow-up are recommended to validate these findings.