J Korean Fract Soc.  2018 Apr;31(2):45-49. 10.12671/jkfs.2018.31.2.45.

How Difficult Is It to Surgically Treat AO-C Type Distal Humerus Fractures for Inexperienced Orthopedic Surgeons?

• Yoo SH
• Kang SW
• Song MH
• Kim YJ
• Bae H

• KMID: 2409759
• DOI: http://doi.org/10.12671/jkfs.2018.31.2.45

Abstract

PURPOSE
Twenty early surgical management cases of distal humerus type-C fractures were analyzed.
MATERIALS AND METHODS
This study analyzed 20 early patients, who received surgical management of distal humerus type-C fractures, and could be followed-ups for more than one year between March of 2013 and May of 2015. The operative time, bone union time, and elbow range of motion were analyzed. The Mayo's functional score was used to evaluate their postoperative function. The primary and secondary complications of each patient immediately after each of their surgery were also reviewed.
RESULTS
All patient groups achieved bone union within an average period of 16.4 weeks. Based on the Mayo functional score, 6, 10, and 4 patients scored excellent, good, and fair, respectively. The average range of motion was a flexion contracture of 14.5° with a follow-up improvement averaging 120.7°. Six patients received nine revision operations due to major and minor complications. Two patients received revision fixation from an inadequate fixating power, and another patient received an ulnar nerve transposition. Other complications included olecranon osteotomy site displacement, superficial operational site infection, and pin loosening.
CONCLUSION
Distal humerus fractures of the AO-C type can cause a range of complications and has a very high rate of revision due to its difficult nature of surgical manageability. Therefore, it is imperative for a surgeon to expect various complications beforehand and a careful approach to their postoperative rehabilitation is essential.

Keyword

Distal humeral fracture; Intra-articular fracture; Dual orthogonal plate fixation

MeSH Terms

Contracture
Elbow
Follow-Up Studies
Humans
Humerus*
Intra-Articular Fractures
Olecranon Process
Operative Time
Orthopedics*
Osteotomy
Range of Motion, Articular
Rehabilitation
Surgeons*
Ulnar Nerve

Figure

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  Fig. 1 Patient suffered fixation loss 3 days after surgery and underwent revision open reduction and internal fixation. Anteroposterior (AP) (A) and lateral (B) radiography 1 day after surgery displays no immediate abnormality. AP (C) and lateral (D) radiography 3 days after surgery shows metal failure at its fixation site. After revision operation, the authors could achieve sound fixation, as shown in AP (E) and lateral (F) radiography.

• 

  Fig. 2 Patient experienced pin migration 3 months after surgery and underwent ulna nerve anterior transposition. Anteroposterior (AP) (A) and lateral (B) radiography 1 day after surgery displays no immediate abnormality. (C) AP radiography 3 months after surgery displays pin migration.

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  Fig. 3 Patient suffered screw breakage and underwent revision open reduction and internal fixation. Anteroposterior (AP) (A) and lateral (B) radiography 1 day after surgery displays no immediate abnormality. (C) AP radiography 6 weeks after surgery shows screw breakage at its lateral condylar plate fixation site. After revision surgery, authors achieved sound fixation, as seen in AP (D) and lateral (E) radiography. (F) One week after the revision operation, there was an olecranon fracture as observed on the lateral radiograph.

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  Fig. 4 Patient had severe swelling and required temporary external fixation before surgery. (A) Anteroposterior (AP) radiography of temporary fixated humerus before surgery. AP (B) and lateral (C) radiography 1 day after surgery displays no immediate abnormality. Two weeks after the operation, olecranon plate irritation caused wound dehiscence, as observed on the photograph (D) and required exchange to tension band wiring, as shown on the lateral radiograph of Fig. 4E.

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