„Impingement“ der posterolateralen Humerusplatte

Background

Double-plate osteosynthesis has to be considered the gold standard for treating complex distal humeral fractures in adults. Impingement of the posterolateral plate with the olecranon or the radial head in extension of the elbow joint is a possible complication after double-plate osteosynthesis with a 90° configuration, especially after olecranon osteotomy.

Objectives

The goal of this study was to analyze the positioning of the posterolateral humeral plate in order to define guidance values for intraoperative application.

Methods

The positioning of the posterolateral humeral plate in relation to the olecranon in full extension of the elbow joint was analyzed in 71 dissected upper extremities of cadavers. Values on the cadavers were measured under image-intensifier control (distal olecranon impingement line) that can be reproduced intraoperatively.

Results

The average distance between the distal edge of the plate and junction of cartilage and bone at the capitulum humeri was 4.8 mm (SD?±?1.2 mm). The average distances from the medial border of the plate to the lateral border of the olecranon fossa and to the lateral epicondyle were 2.5 mm (SD?±?0.9 mm) and 22.7 mm (SD?±?2.4 mm), respectively. The distal olecranon impingement line averaged 5.2 mm (SD?±?1.5 mm) on the left and 7.2 mm (SD?±?1.4 mm) on the right side of cadavers.

Conclusions

The measured values offer landmarks for correct positioning of the posterolateral humeral plate. The distance between the lateral border of the olecranon fossa and the medial edge of the posterolateral plate as well as the proximal end of the distal olecranon impingement line should be respected in order to avoid impingement. If possible, the posterolateral plate should be placed at least 4.3 mm lateral to the radial edge of the olecranon fossa so that impingement can be successfully avoided.     

Surgical exposures of the distal humeral fractures: An anatomical study of theanterior, posterior, medial and lateral approaches

Purpose

Exposure of the articular surface is the key to the successful treatment of intra-articular fractures of distal humerus. Anterior, posterior olecranon osteotomy as well as medial and lateral approaches are the four main approaches to the elbow. The aim of this study was to compare the exposure of distal articular surfaces of these surgical approaches.

Primärer endoprothetischer Ellbogengelenkersatz bei komplexen intraartikulären distalen Humerusfrakturen

Introduction

Open reduction and internal fixation of multifragmentary intra-articular fractures of the distal humerus often do not provide satisfactory results in elderly patients with osteoporosis.

Method

From December 2001 to January 2008 a total elbow arthroplasty (Coonrad-Morrey, Zimmer, USA) was performed on 12 patients (average age 81±9  ears) who presented with a type C distal humeral fracture. The mean time of follow-up with clinical and radiological assessment was 28±17 months.

Results

The Mayo score showed a good functional result with an average of 81±9 out of 100. DASH and SECEC scores showed a fair result with respect to elbow function (43±8 and 68±7 points, respectively). The average range of motion of all patients was 120-33-0°. Heterotopic ossifications were found by X-ray examination in 4 cases and asymptomatic radiolucent lines in 4 cases.

Conclusion

Primary total elbow arthroplasty for complex intra-articular distal humerus fractures in elderly patients has good functional results and is an alternative to osteosynthesis.     

Comparing approaches to expose type C fractures of the distal humerus for ORIF in elderly patients: six years clinical experience with both the triceps-sparing approach and olecranon osteotomy

Background

Although open reduction and internal fixation (ORIF) is a standard fracture treatment method, the optimal way to expose a fracture prior to ORIF is debated. We compared the effects of two exposure methods, the triceps-sparing approach and olecranon osteotomy, on the functional outcomes of ORIF-treated type C distal humerus fractures in elderly people.

Methods

From January 2006 to January 2011, 75 elderly patients with type C distal humerus fractures were treated with ORIF, and we retrospectively reviewed their medical records, radiographs, and follow-up charts to identify any complications. Patients’ Mayo Elbow Performance Score (MEPS) and range of motion were determined at their final clinic visit.

Results

Sixty-seven patients (89 %) attended the final visit. Of these patients, 36 received olecranon osteotomy and 31 received the triceps-sparing approach. For patients with type C1 and C2 fractures, we observed reductions in procedure times, blood loss, complication rates, and MEPS outcomes (all P < 0.01) with the triceps-sparing approach compared with olecranon osteotomy. Except for MEPS outcomes, all of these approach-related improvements were also statistically significantly for type C3 fractures (all P < 0.01). Overall, we did not observe any cases of fracture nonunion, implantation breakage or loosening, or elbow stiffening in our series.

Conclusions

In our study, we found better functional outcomes for type C1 and C2 distal humerus fractures that were exposed using the triceps-sparing approach rather than olecranon osteotomy. Even for the most complex type of fracture, C3 fractures, similar recoveries in elbow function were achieved using either approach.

Level of evidence

Level III.     

Fixing simple olecranon fractures with the Olecranon Osteotomy Nail (OleON)

Objective

Stable fixation of simple olecranon fractures or olecranon osteotomies in order to allow early functional treatment.

Indications

Simple (non-comminuted) olecranon fractures and (Chevron) osteotomies of the olecranon.

Contraindications

Comminuted fractures and fractures more than 40?mm distal than the tip of the olecranon are contraindications.

Surgical technique

Using a slightly curved posterior approach, the fracture is anatomically reduced. The fracture is temporary stabilized using K-wires. A guiding K-wire is positioned centrally in the medullary canal in the lateral projection. The medullary canal is reamed over the K-wire. The distal part of the nail is inserted and locked. The proximal part is inserted and screwed onto the distal part to compress the fracture. For osteotomies, the distal part is inserted and locked (using the same technique as described before) prior to performing the osteotomy. At the end of the surgery, the osteotomy is reduced, the proximal part is inserted, and the osteotomy is compressed.

Postoperative management

As the stability of this compressive osteosynthesis is very high, early post-operative mobilization is allowed. No immobilization is used. Depending on the soft tissue situation, active range of motion and passive stretching is initiated immediately postoperatively.

Results

Using this technique in 21?patients (mean age 42?years) with acute fractures or osteotomies, sound fracture healing was achieved in 19 of 21?patients. The active range of motion was 130.2° flexion, 10.6° extension deficit, and a normal pro-supination arch. In one patient, delayed union caused implant failure. In this patient, a surgical error jeopardized stability. In a second patient, a peri-implant fracture after adequate trauma made a change in therapy necessary.     

Double-locking precontoured plating system for malunited fractures of the distal end of humerus

Background

Distal humeral malunions are uncommon injuries, often associated with limited elbow motion, pain, instability, weakness, and sometimes ulnar neuritis. The complex anatomy of the elbow joint makes this condition one of the most complex elbow injuries to treat.

Materials and methods

Four patients were treated by the same surgeon between 2011 and 2013 using a double-locking precontoured plating system for malunited intra-articular or extra-articular fractures of the distal end of the humerus.

Results

At a mean 3 years of follow-up, a significant improvement in the elbow motion and functional outcome, evaluated with the Mayo Elbow Performance Index and the Disability of the Arm, Shoulder, and Hand, were observed. Articular reduction obtained after the surgery was maintained in all patients without evidence of avascular necrosis. No other complications (i.e., infection, nervous iatrogenic lesions) were reported.

Conclusions

Corrective osteotomy using double-locking precontoured plating system preceded by preoperative planning using a CT scan allowed an improvement in the functional outcome and elbow motion, without complications.

     

Kirschner-Draht-Osteosynthese von Frakturen des Condylus radialis im Kindes- und Jugendalter

Question

Aim of the study was the evaluation of the results of an operative treatment of dislocated lateral humeral condyle fractures in children and adolescents.

Patients

Over a period of 4 years 58 children with lateral humeral condyle fractures were treated operatively by a Kirschner wire (K-wire) osteosynthesis. The patients were recorded prospectively and clinical follow-up examinations were done.

Results

A total of 36 boys and 22 girls with an average age of 6.4 (range 2–15) years were included in the study with 46 isolated lateral humeral condyle fractures. In 12 cases additional injuries included 4 elbow luxations, 4 fractures of the olecranon, 2 distal forearm fractures and 2 children suffered from multiple injuries. Only closed fractures were identified of which 14 were reduced percutaneously and fixed with two K-wires and in 44 cases an open reduction with K-wire fixation was necessary. All children were provided with casts for a period of 4–6 weeks and the K-wire was removed 10–12 weeks after the operation. The average duration of the hospital stay was 2.9 (range 1–25) days. At the time of metal removal all fractures were completely consolidated. No pseudarthrosis occurred but complications included dislocation of K-wires (n=3) and bursitis (n=5). A fishtail deformity could be shown radiographically in 5 children. Follow-up examinations could be carried out in 53 children for an average time of 13 months (range 4–58). Of the patients 47 showed free functions, in 5 patients there was a lack of extension between 5 and 10° and in 1 patient of 15°. One child had a varus deformity of about 5° and another child of about 10°. Of the parents 49 were very content and 4 parents were content with the course of treatment and the results.

Conclusion

The K-wire osteosynthesis of lateral humeral condyle fractures is an efficient and safe treatment with low complication rates and good results.     

AO extra-articular distal humerus locking plate: extended spectrum of usage in intra-articular distal fractures with metaphyseal extension—our experience with 20 cases

Background

LCP extra-articular plate designed by AO has been used in extra-articular fractures of the distal humerus, mal-unions, and nonunions of the distal humerus. They provide anatomically shaped and angular stable fixation system for extra-articular fractures of the distal humerus. We extended the usage spectrum of this plate to the extra-articular with intra-articular distal humerus fractures and compared it with the standard orthogonal locking plate fixation.

Methods

We included 22 consecutive distal humerus intra-articular fractures with metaphyseal and diaphyseal extension into the study. Each case underwent osteosynthesis with LCP extra-articular plate fixation and augmented the intra-articular fragments with 4.0 mm partially threaded cancellous screws. The cost, surgical time, VAS, Modified Mayo Clinic Performance Index for elbow, and postoperative complications were recorded. The radiological union and postoperative elbow range of motion were assessed at 6 weeks, 6, and 12 months of follow-up. Twenty cases completed the scheduled follow-up. The results were compared with retrospective data of 20 cases from our institute where similar fractures were treated with standard orthogonal LCP distal humerus plate (LCPDHP).

Results

The radiological union rates and the range of motion at 6 weeks, 6, and 12 months in both the groups were comparable and did not vary significantly (p > 0.05). The cost and operative time with the LCP extra-articular plates were significantly less (p < 0.05) when compared to the group LCPDHP.

Conclusion

The usage spectrum of extra-articular distal humerus locking plate can be extended to intra-articular fractures. It provides good results and significantly reduces the cost and operative time.     

Surgical management of intercondylar fractures of the humerus using triceps reflecting anconeus pedicle (TRAP) approach

Background:

Operative fixation of intra-articular fractures of the distal humerus requires adequate exposure. The transolecranon approach is a commonly used approach. The olecranon osteotomy has potential complications related to prominence/migration of hardware, displacement/nonunion of osteotomy and triceps weakness. Triceps-reflecting anconeus pedicle (TRAP) approach avoids the olecranon osteotomy without compromising the operative exposure. We present outcome of fixation of displaced intra-articular distal humeral fractures with the use of TRAP approach.

Materials and Methods:

We reviewed the functional and radiological results of 40 consecutive patients with intercondylar fractures of the humerus treated by internal fixation through TRAP approach. There were 28 males and 12 females and the average age was 32 ± 4.5 years. The right elbow was involved in 27 patients and the left elbow in 13 patients. The mechanism of injury was a fall in 20 patients, a motor-vehicle accident in 16 patients and direct trauma in four patients.

Results:

At a minimum follow-up of 12 months (average 18 ± 4 months) 35 (87.5%) patients had good triceps strength. The average range of motion was 118.4 ± 7 degrees (range 80°-130°). The average time to union was 3.2 ± 1.6 months (range two to six months). No patient had triceps rupture, implant failure, neurovascular deficit or nonunion. Two patients needed removal of the implant because of subcutaneous prominence.

Conclusions:

The TRAP approach provides good visualization for fixation of intercondylar fractures of the humerus, without any noticeable untoward effect on triceps strength and postoperative rehabilitation; and one can avoid iatrogenic fracture of the olecranon and its associated complications.     

Biomechanical comparison of intramedullar versus extramedullar stabilization of intra-articular tibial plateau fractures

Background

Fractures of the proximal tibia occur very often and are a great challenge for trauma surgeons to stabilize. Although locked nails were developed to stabilize these fractures, this technique has not been sufficiently investigated. The purpose of this study was to biomechanically assess the stability of locked intramedullary nailing compared to locked plating.

Methods

16 fresh frozen human cadaveric tibiae were osteotomized in the meta-diaphyseal intersection with an osteotomy gap of 10 mm and a single osteotomy through the medial epicondyle to simulate a 41-C.2 fracture. Stabilization was performed with an angle stable locked Targon-TX nail (n = 8) and two additional canulated screws. The other testing group (n = 8) was treated with two canulated screws and a five-hole LCP-PLT. The bones were tested in a cyclic testing protocol with increasing loads under compression and a load sharing of 60 % through the medial tibial plateau and 40 % to the lateral side. Stiffness and fracture gap movement were measured and failure mode was assessed.

Results

No significant differences were found between the two implants regarding load until failure. The stiffness of the intramedullary nailing group (927 N/mm) was statistically significantly higher than the stiffness of the plating group (564 N/mm). No differences were found for fracture gap movement in the z-axis. However, differences were found for dislocation of the proximal-lateral and proximal-medial fragments, with absolute values of 0.099 mm in the plate group and 0.66 mm in the nailing group at 800 N. Prior to failure, fracture gap movement was 0.22 mm for the plating group and 1.66 mm for the nailing group, a difference that was also statistically significantly different. The nailing group failed by screw cut-out while the plating group failed by screw breakage.

Conclusion

Nailing of proximal tibia fractures leads to a stiffer implant-bone construct than plating. Since no adverse effects were found after nailing it seems to be a good alternative to plating for intra-articular proximal tibia fractures, especially in patients with soft tissue problems.     

Open reduction and bi-columnar internal fixation of intra-articular distal humerus fractures through a combined medial and lateral approach

Purpose

The aim of this retrospective study was to investigate the suitability of bi-columnar internal fixation through a combined medial and lateral approach for the treatment of intra-articular distal humerus fractures.

Methods

Nineteen cases of intra-articular distal humerus fractures were treated with open reduction and bi-columnar internal fixation through a combined medial and lateral approach. The reduction in the articular surface and functional recovery of the affected elbows was assessed at an average follow-up of 15.8 ± 7.9 (7–43) months.

Results

The gap in the main articular fragments was less than 1 mm in 16 cases, while a gap of more than 1 mm and less than 2 mm was identified in 2 cases and of 3.7 mm in one case. All the fractures were united. At the latest follow-up, the mean flexion–extension of the elbows was 113.4° ± 20.7°, while the pronation–supination of the forearms was 158.3° ± 8.5°, and the mean Mayo Elbow Performance Index was 93.7 ± 9.1 points, leading to 13 excellent outcomes, and 6 with good results.

Conclusions

Intra-articular fractures of the distal humerus can be effectively treated by open reduction and internal fixation through a combined medial and lateral approach at the elbow.     

Digastric trochanteric flip osteotomy and surgical dislocation of hip in the management of acetabular fractures

Objectives

To assess the efficacy and safety of digastric trochanteric flip osteotomy technique in the management of acetabular fractures and to evaluate surgical outcome in terms of fracture reduction, femoral head viability of selected acetabular fractures treated operatively using a digastric trochanteric flip osteotomy and a modified Kocher–Langenbeck approach with surgical dislocation of the femoral head.

Design

Prospective.

Patients

Eighteen patients predominantly with combined transverse and posterior wall fractures or multifragmentary posterior wall fractures.

Outcome evaluation

Clinical and radiographic analysis after a minimum 18 months follow-up.

Methods

A single modified approach involving digastric trochanteric flip osteotomy and a modified Kocher–Langenbeck approach with anterior (n = 14) or posterior (n = 4) surgical dislocation of the femoral head, was done for one or more of following reasons: intra-articular assessment of reduction in fractures with comminution, marginal impaction and involvement of the anterior column, removal of intra-articular fragments, and confirmation of extra-articular screw placement.

Results

At a mean follow-up of 26 months (18–40 months), the 17 patients presented with a good to excellent clinical result according to the d’Aubigné score. In all subjects, anatomical reduction was achieved during surgery. The osteotomy site healed at an average of 7 weeks and all the patients recovered abductor strength at 12 weeks. One avascular necrosis occurred in a case of posterior column plus wall fracture (who presented to us after 3 weeks). No heterotopic ossification interfering with hip function was found.

Conclusion

This technique gives good exposure (especially in posterior wall, dome area, posterior fracture-dislocation with intra-articular fragments/femoral head fractures and T-fractures), preservation of abductor strength (which may be lost with excessive retraction of abductors to see dome area in classical posterior approach), reliable healing of osteotomy (in contrast to conventional trochanteric osteotomy) without risking the vascularity of femoral head.     

Die Ellenbogenfrakturprothese beim alten Menschen

Background

Due to the aging of the German population, the number of patients with osteoporosis and associated fractures is rising. While the negative effects on elderly patients after fractures of the hip region are well known, little information on the effects of fractures of the upper extremities exists. Nevertheless, a flexible and painfree elbow is necessary for an autonomous life. On the other hand, in case of an osteoporotic distal humeral fracture, longer immobilization or even secondary loss of the reduction due to the poor bone quality is well known.

Material and methods

Over the past 4 years, we implanted 19 elbow prostheses in geriatric patients. We used two different types of implants. This retrospective study analyzes the indications, the applied technique, and the clinical and radiological results.

Results

The average age was 75 years. We treated 15 women and 4 men. Type C1, C2, or C3 fractures were found in 15 cases and B2 fractures in 4 patients. Concomitant osteoporosis was detected in 14 patients. In almost all cases, the fracture site was located very low, i.e., at the lower margin of the fossa cubitalis. On average, 85 points were reached in the Mayo Elbow Score. In three patients a transitory N. ulnaris irritation and in one case a sterile loosening of an ulnar stem occurred. There were no infections.

Conclusions

Our experience using an elbow joint replacement in cases of osteoporotic articular fractures in geriatric patients is positive. A high range of motion plus freedom of pain can be achieved. However, internal osteosynthesis should be performed in geriatric patients, if it is possible based on the fracture and bone quality.     

Posterior percutaneous plating of the humerus

Objective

This is a prospective case series study, which was designed to evaluate the clinical outcome of posterior percutaneous plating of the humerus.

Materials and methods

From the year 2010 to 2011, 37 patients with middle and distal third humeral fractures who met the inclusion criteria were surgically treated by minimally invasive plate osteosynthesis through posterior approach. Their age ranged from 19 to 43 with an average of 27.8 years. Type of fractures varied from B to C, and all of them were traumatic.

Results

Patients were followed up for a period varied from 12 to 24 months with an average of 18. There were no cases of intraoperative complications, infection or metal failure. Union was achieved in all of them within 16–21 weeks with an average of 18. Iatrogenic postoperative temporary neuropraxia of the radial nerve palsy was observed in two patients. All patients achieved normal range of shoulder and elbow motion within 3 months after surgery. The average Quick DASH score at 12-month follow-up was 30. According to patient’s satisfaction, all of them returned to the usual pre-injury activity level within 6 months.

Conclusions

This study suggests that the principles of minimally invasive plate osteosynthesis can be applied safely through posterior approach of the humerus to treat middle and distal third humeral fractures. This approach has the advantage of preserving the triceps anatomy and function facilitating rapid postoperative rehabilitation.     

Outcomes and complications of fractures of distal radius (AO type B and C): volar plating versus nonoperative treatment

Objectives

Management of AO type B and C fractures of the distal radius is controversial. This study compares outcomes and complications of AO type B and C fractures of the distal radius treated with volar locked plating and nonoperative methods.

Materials and methods

Sixty-four patients with fractures of the distal radius (AO type B and C) were included in this study, according to inclusion criteria, and were allocated to the volar plating group or nonoperative group by alternate randomization: 32 patients with odd numbers went into the nonoperative group and the other 32 with even numbers went into the volar plating group. Patients in the nonoperative group were managed with closed reduction of the fracture and plaster cast application under an image intensifier. Those in the volar plating group were managed by open reduction and fixation with a volar locked plate. Preoperative and postoperative serial clinico-radiological follow-up was done. The range of movement, grip strength, functional outcome scores and radiological parameters were compared. Student’s t-test was used for statistical analysis with significance at p < 0.05.

Results

Range of movement and functional scores were significantly (p < 0.001) better in the volar plating group, but the difference in ulnar variance and radial and ulnar deviation was insignificant as compared to the nonoperative group. At 24 months follow-up, the nonoperative group had significantly more cases with malunion, articular incongruity and osteoarthritis.

Conclusion

In cases of AO type B or C fractures of the distal radius, volar locked plating provides anatomical stable fixation and early mobilization with better clinico-radiological outcome as compared to conservative treatment.     

Less invasive surgery with wrist arthroscopy for distal radius fracture

Background

We developed a surgical procedure that can facilitate arthroscopic intervention for volar locking plate fixation for distal radius fracture (DRF) with a less invasive technique. This study is to investigate the effectiveness of our original procedure for the treatment of DRF.

Methods

One hundred fifty-five wrists of 153 consecutive patients underwent our original procedure: the plate presetting arthroscopic reduction technique (PART) for DRF. The fractures consisted of 37 extra-articular and 118 intra-articular fractures. The fractures were reduced, anatomical alignment was regained with the aid of an image intensifier, and the volar locking plate was preset. Wrist arthroscopy was then performed and the intra-articular condition assessed. If there were any residual dislocations of the intra-articular fragments, these were reduced arthroscopically, and soft tissue injuries were subsequently treated. The traction was then removed, and the plate was securely fixed. One hundred forty-five patients were followed up from 12 to 48 months. The final outcome was evaluated with the Mayo modified wrist score and Disability of the Arm, Shoulder and Hand questionnaire (DASH). The effectiveness of arthroscopy was also investigated.

Result

On arthroscopic inspection, intra-articular dislocations were found to be residual in 35.2 %, even if reduction seemed to have been achieved when viewed with the image intensifier. Scapholunate interosseous ligament injury was recognized in 28.9 %, and triangular fibrocartilage complex injury was observed in 63.2 %. The final outcome was 112 excellent, 31 good, and 2 fair. The mean DASH score was 4.1.

Conclusion

We developed the PART to simplify the combination of volar locking plating and arthroscopy. This technique was less invasive and effective in the treatment of DRF.     

Osteotomie am distalen Femur zur Korrektur von Genu valgum und Torsionsfehlern

Objective

Femoral medial closing wedge osteotomy for the correction of valgus malalignment to unload the cartilage in the lateral compartment and/or correction of symptomatic torsional malalignment.

Indications

Lateral unicompartmental osteoarthritis of the knee with genu valgum in young patients. Symptomatic torsional malalignement of >?30° and <?0°.

Contraindications

Grade 3 and 4 cartilage damage in the medial compartment. Heavy smoking. Medial meniscectomy. Extreme obesity. Inadequate soft tissue conditions.

Surgical technique

The operation begins with arthroscopy of the knee joint. In case of grade 4 lateral cartilage damage, a microfracture is performed. The distal femur is exposed via an anteromedial longitudinal incision starting 10 cm above the patella and ending in the upper third of the patella. The medial femoral cortex is exposed using Hohmann retractors and an oblique closing wedge osteotomy is performed with an oscillating saw. In case of valgus correction, the lateral cortex is left intact. In case of correction of torsional malalignment, the osteotomy plane is horizontal and the lateral cortex is cut. The wedge height is determined preoperatively based on full leg x-rays. The leg axis is controlled intraoperatively with a long metal rod and the use of an image intensifier. The osteotomy is manually closed and stabilized with a locking plate.

Postoperative management

The patient is mobilized under load with 20 kg body weight for the first 6 postoperative weeks. Full range of motion is permitted.

Results

We treated 23 patients with lateral cartilage damage (grades 3 and 4) and genu valgum with medial closing osteotomy of the distal femur (6 men and 17 women). After 3.5-years follow-up, the KOOS increased from 48.4 points to 84.9 points. In one case, there was an early loss of correction, with subsequent revision with bone grafting and lateral osteosynthesis. No peri-or postoperative complications such as infection, thrombosis, and embolism occurred [24]. In 5 cases a torsional osteotomy was performed. The torsional osteotomy was performed 4 times due to chronic patellofemoral instability, and once due to a medial tibiofemoral instability. Healing complications were not observed in this population. Recurrent instability was not observed.     

Internal fixation of humeral shaft fractures using minimally invasive plating: comparative study of two implants

Purpose

We compared the results of two types of implants, dynamic compression plates (DCPs) and locking compression plates (LCPs), applied to correct mid-distal third humeral shaft fractures using minimally invasive plating osteosynthesis (MIPO).

Methods

Data of 43 patients with mid-distal third humeral shaft fractures treated using MIPO were retrospectively analyzed. Patients were divided into two groups according to the implants applied: group A (n = 26), those whose fractures were fixed with 4.5-mm DCP, and group B (n = 17) fixed with 4.5-mm LCP or metaphyseal LCP. The outcomes of the two groups in terms of operative time, time of fracture union, occurrence of early and late postoperative complications, University of California—Los Angeles (UCLA) End-Result score and the Mayo Elbow Performance Index (MEPI) were compared.

Results

The mean operative time was 107.8 ± 33.1 min in group A and 91.2 ± 40.4 min in group B (p > 0.05). The mean time of fracture union was 16.77 ± 6.01 weeks in group A and 14.59 ± 5.73 weeks in group B (p > 0.05). Seven (26.9 %) patients had postoperative complications in group A and 3 (17.6 %) in group B (p > 0.05). The mean UCLA End-Result score in group A was 34.31 ± 1.26 points and 33.12 ± 2.76 points in group B (p > 0.05). The mean MEPI was 100.00 ± 0.00 points in group A and 97.35 ± 7.52 points in group B (p > 0.05).

Conclusions

In surgical stabilization of mid-distal humeral shaft fractures using MIPO, application of DCP or LCP resulted in good outcomes, there were no significant differences between the outcomes of these two types of implant.     

The interference of distal humeral plating with the medial and lateral collateral ligaments of the elbow

Introduction

The aim of the present study was to determine the anatomical relationship and evaluate the potential interference of today’s common distal humerus plates with the medial and lateral collateral ligaments of the elbow.

Materials and methods

The elbow joints of 23 embalmed upper extremities were dissected. Three different brands of distal humerus double-plating systems were applied in a standardized fashion. We used a caliper to measure the amount of absolute overlap of the plates on the corresponding collateral ligaments.

Results

The data show contact and overlap with the medial and lateral collateral ligaments in all tested medial and lateral plates. The posterolateral and posteromedial plates showed no contact with the ligaments, yet they did contact the posterior joint capsules. The medial plates showed less contact/overlap when compared with the lateral and extended medial plates.

Conclusion

Based on the present data, we conclude that distal humerus plating using the perpendicular technique with standard-sized medial plates shows the least amount of overlap over the medial and lateral collateral ligaments. The extent of the overlap of the ligaments by the humeral plates is clearly shown in the present study.