Clin Orthop Surg.  2016 Mar;8(1):9-18. 10.4055/cios.2016.8.1.9.

Triangular Fixation Technique for Bicolumn Restoration in Treatment of Distal Humerus Intercondylar Fracture

• Jung SW
• Kang SH
• Jeong M
• Lim HS

• KMID: 2363940
• DOI: http://doi.org/10.4055/cios.2016.8.1.9

Abstract

BACKGROUND
Distal humerus intercondylar fractures are intra-articular and comminuted fractures involving soft tissue injury. As distal humerus is triangle-shaped, parallel plating coupled with articular fixation would be suitable for bicolumn restoration in treatment of distal humerus intercondylar fracture.
METHODS
This study included 38 patients (15 males and 23 females) who underwent olecranon osteotomy, open reduction and internal fixation with the triangle-shaped cannulated screw and parallel locking plates (triangular fixation technique). Functional results were assessed with the visual analog scale (VAS) scores, Mayo elbow performance (MEP) scores and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires. Anteroposterior and lateral elbow radiographs were assessed for reduction, alignment, fracture union, posttraumatic arthrosis, and heterotopic ossification, and computed tomography (CT) scans were used to obtain more accurate measurements of articular discrepancy.
RESULTS
All fractures healed primarily with no loss of reduction. The mean VAS, MEP, and DASH scores of the affected elbow were not significantly different from those of the unaffected elbow (p = 0.140, p = 0.090, and p = 0.262, respectively). The mean degree of flexion was significantly lower in the affected elbow than in the unaffected elbow, but was still considered as functional (p = 0.001, > 100degrees in 33 of 38 patients). Two cases of articular step-offs (> 2 mm) were seen on follow-up CT scans, but not significantly higher in the affected elbow than in the unaffected elbow (p = 0.657). Binary logistic regression analysis revealed that only Association for Osteosynthesis (AO) type C3 fractures correlated with good/excellent functional outcome (p = 0.012). Complications occurred in 12 of the 38 patients, and the overall reoperation rate for complications was 10.5% (4 of 38 patients).
CONCLUSIONS
Triangular fixation technique for bicolumn restoration was an effective and reliable method in treatment of distal humerus intercondylar fracture. This technique maintained articular congruency and restored both medial and lateral columns, resulting in good elbow function.

Keyword

Humeral fractures; Intra-articular fractures; Fracture fixation

MeSH Terms

Adult
Aged
Aged, 80 and over
Female
Fracture Fixation, Internal/adverse effects/*methods/statistics & numerical data
Humans
Humeral Fractures/*surgery
Intra-Articular Fractures/*surgery
Male
Middle Aged
Postoperative Complications
Range of Motion, Articular
Retrospective Studies
Treatment Outcome

Figure

• 

  Fig. 1 (A) Schematic illustration demonstrates that distal humerus is composed of lateral and medial columns with the trochlea situated between these columns to form a triangular construct. (B, C) Schematic illustrations demonstrate that the articular congruency is first anatomically reduced with a cannulated screw and the columns are stably fixed with double plates (triangular fixation). (D) The postoperative anteroposterior radiograph shows triangle-shaped screw and plate fixation.

• 

  Fig. 2 (A) Postoperative 1-year computed tomography scan of a 59-year-old woman demonstrates good articular congruency in the coronal oblique view. (B) Follow-up computed tomography scan of a 68-year-old man demonstrates articular step-off in the coronal oblique view.

• 

  Fig. 3 (A, B) Initial anteroposterior and lateral radiographs of a 65-year-old man show a displaced Association for Osteosynthesis (AO) type C2 distal humerus intercondylar fracture. (C, D) Postoperative 1-year anteroposterior and lateral radiographs show bone union and good alignment.

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