J Korean Orthop Assoc.  2016 Aug;51(4):301-307. 10.4055/jkoa.2016.51.4.301.

Clinical Results of Open Reduction and Internal Fixation in the Coronal Plane Articular Fracture of the Distal Humerus

• Byun YS
• Shin DJ
• Dan JM
• Lee SM
• Jeong DG
• Gu TH
• Ha SS

• KMID: 2348636
• DOI: http://doi.org/10.4055/jkoa.2016.51.4.301

Abstract

PURPOSE
The purpose of this study is to evaluate the surgical outcomes according to the Ring's classification system in patients with the distal humeral coronal plane articular fracture after treatment with open reduction and internal fixation (OR/IF).
MATERIALS AND METHODS
Patients with the distal humeral coronal plane articular fracture treated with OR/IF in the three hospitals were reviewed retrospectively. The patients were evaluated clinically and radiographically according to the Ring's classification system.
RESULTS
Eleven patients, including three males and eight female patients, with a mean age of 55 years (15-88 years) were enrolled in this study. Average Mayo elbow performance score was 85 (60-100), four patients had excellent, four had good, and three had fair results. Fracture union was achieved in ten of 11 patients who underwent open reduction and internal fixation. In the analysis of the results according to Ring's classification, patients presenting fracture of the posterior aspect of the lateral column showed worse clinical results than those who did not. It was the same for the patient presenting fracture of the posterior aspect of the trochlea.
CONCLUSION
The open reduction and internal fixation provides good clinical and radiologic outcomes for the distal humeral coronal plane articular fracture. Our results suggest that the type of fracture involvement with posterior aspect of trochlear or capitellum can result in poor clinical outcomes.

Keyword

elbow; humerus; coronal fracture; Ring's classification

MeSH Terms

Classification
Elbow
Female
Humans
Humerus*
Male
Retrospective Studies

Figure

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  Figure 1 Distal humerus articular surface, demonstrating the location of the five components of the articular fracture.

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  Figure 2 A 16-year-old male fell on the ground and injured the left elbow. (A, B) Antero-posterior X-ray and lateral X-ray and computed tomography of a type 2 distal humerus capitellar coronal shear fracture. (C) Intraoperative photo of the fracture. (D) Twenty-month postoperative anteroposterior and lateral X-ray of the patient fixed with a plate and screws. The patient had an excellent result.

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  Figure 3 A 69-year-old female fell on the ground and injuried the left elbow. (A, B) X-ray and computed tomography of a type 5 distal humerus capitellar coronal shear fracture. (C, D) Postoperative anteroposterior X-ray of patient treated with the total elbow arthroplasty. The patient had good result.

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  Figure 4 A 56-year-old female fell on the ground and injured the left elbow. (A, B) Anteroposterior X-ray and computed tomography of a type 4 distal humerus capitellar coronal shear fracture. (C) Postoperative anteroposterior X-ray of the patient fixed with multiple K-wires. K-wires were removed after one-year. (D) Anteroposterior X-ray taken after ten-months after removal of K-wires shows the non-union of fracture.

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