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Skinny wire and locking plate fixation for comminuted intra-articular distal humerus fractures: a technical trick and case series

INTRODUCTION: Intra-articular distal humerus fractures present a challenge to orthopedic surgeons. Stable fixation is difficult to achieve in fractures with articular and metaphyseal comminution and osteoporotic bone. Hence, these fractures are more commonly being managed with total elbow arthroplas...

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Autores principales: Olson, Jeffrey J., Dyer, George S.M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10426594/
https://www.ncbi.nlm.nih.gov/pubmed/37588629
http://dx.doi.org/10.1016/j.xrrt.2020.11.007
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author Olson, Jeffrey J.
Dyer, George S.M.
author_facet Olson, Jeffrey J.
Dyer, George S.M.
author_sort Olson, Jeffrey J.
collection PubMed
description INTRODUCTION: Intra-articular distal humerus fractures present a challenge to orthopedic surgeons. Stable fixation is difficult to achieve in fractures with articular and metaphyseal comminution and osteoporotic bone. Hence, these fractures are more commonly being managed with total elbow arthroplasty. We describe a novel surgical technique that confers stable fixation, allowing for early range of motion resulting in a high rate of union, a functional range of motion, and excellent patient reported outcome scores without the activity restrictions of total elbow arthroplasty. METHODS: Retrospective case series of 30 patients with AO/OTA type B and C intra-articular distal humerus fractures who underwent ORIF from 2014-2019 utilizing a novel surgical technique that focuses on reconstructing a comminuted articular surface through meticulous, transverse fixation of the tiny articular fragments with long, thin Kirchner wires, which are then bent over and trapped under locking compression plates to create a fixed angle support to the metadiaphysis. RESULTS: Patient mean age of 59 (19-90) years and 61% were female. Median follow up was 1.2 years. Twenty-seven (87%) were type C fractures and 3 (13%) were type B. Five patients (16%) suffered a concurrent ipsilateral upper extremity injury and four (13%) had an open fracture. Two were polytrauma patients. All fractures healed with an average time to union of 11 weeks. Over 80% patients reported no or mild pain at final follow up. Mean arc of elbow motion was 102 degrees, mean QuickDASH score 25.2. Post-operative complications included ulnar nerve paresthesias (38%), wound infection (3.2%), heterotopic ossification (3.2%), and olecranon nonunion (3.2%). Eight patients underwent secondary procedures: 7 (23%) removal hardware, 3(9.6%) capsular release, 2 (6.4%) ulnar nerve transpositions, and 1 (3.2%) total elbow arthroplasty. CONCLUSION: We describe a novel surgical technique that we believe results in strong, stable fixation of complex intra-articular distal humerus fractures irrespective of bone quality. In our series, all fractures healed and post-operatively patients reported low levels of pain, achieved excellent elbow range of motion, high patient reported outcome scores. Patients should be counseled about high rates of post-operative ulnar nerve paresthesias that can be expected to improve over time and high reoperation rates for symptomatic hardware.
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spelling pubmed-104265942023-08-16 Skinny wire and locking plate fixation for comminuted intra-articular distal humerus fractures: a technical trick and case series Olson, Jeffrey J. Dyer, George S.M. JSES Rev Rep Tech Original Article INTRODUCTION: Intra-articular distal humerus fractures present a challenge to orthopedic surgeons. Stable fixation is difficult to achieve in fractures with articular and metaphyseal comminution and osteoporotic bone. Hence, these fractures are more commonly being managed with total elbow arthroplasty. We describe a novel surgical technique that confers stable fixation, allowing for early range of motion resulting in a high rate of union, a functional range of motion, and excellent patient reported outcome scores without the activity restrictions of total elbow arthroplasty. METHODS: Retrospective case series of 30 patients with AO/OTA type B and C intra-articular distal humerus fractures who underwent ORIF from 2014-2019 utilizing a novel surgical technique that focuses on reconstructing a comminuted articular surface through meticulous, transverse fixation of the tiny articular fragments with long, thin Kirchner wires, which are then bent over and trapped under locking compression plates to create a fixed angle support to the metadiaphysis. RESULTS: Patient mean age of 59 (19-90) years and 61% were female. Median follow up was 1.2 years. Twenty-seven (87%) were type C fractures and 3 (13%) were type B. Five patients (16%) suffered a concurrent ipsilateral upper extremity injury and four (13%) had an open fracture. Two were polytrauma patients. All fractures healed with an average time to union of 11 weeks. Over 80% patients reported no or mild pain at final follow up. Mean arc of elbow motion was 102 degrees, mean QuickDASH score 25.2. Post-operative complications included ulnar nerve paresthesias (38%), wound infection (3.2%), heterotopic ossification (3.2%), and olecranon nonunion (3.2%). Eight patients underwent secondary procedures: 7 (23%) removal hardware, 3(9.6%) capsular release, 2 (6.4%) ulnar nerve transpositions, and 1 (3.2%) total elbow arthroplasty. CONCLUSION: We describe a novel surgical technique that we believe results in strong, stable fixation of complex intra-articular distal humerus fractures irrespective of bone quality. In our series, all fractures healed and post-operatively patients reported low levels of pain, achieved excellent elbow range of motion, high patient reported outcome scores. Patients should be counseled about high rates of post-operative ulnar nerve paresthesias that can be expected to improve over time and high reoperation rates for symptomatic hardware. Elsevier 2020-12-15 /pmc/articles/PMC10426594/ /pubmed/37588629 http://dx.doi.org/10.1016/j.xrrt.2020.11.007 Text en © 2020 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Olson, Jeffrey J.
Dyer, George S.M.
Skinny wire and locking plate fixation for comminuted intra-articular distal humerus fractures: a technical trick and case series
title Skinny wire and locking plate fixation for comminuted intra-articular distal humerus fractures: a technical trick and case series
title_full Skinny wire and locking plate fixation for comminuted intra-articular distal humerus fractures: a technical trick and case series
title_fullStr Skinny wire and locking plate fixation for comminuted intra-articular distal humerus fractures: a technical trick and case series
title_full_unstemmed Skinny wire and locking plate fixation for comminuted intra-articular distal humerus fractures: a technical trick and case series
title_short Skinny wire and locking plate fixation for comminuted intra-articular distal humerus fractures: a technical trick and case series
title_sort skinny wire and locking plate fixation for comminuted intra-articular distal humerus fractures: a technical trick and case series
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10426594/
https://www.ncbi.nlm.nih.gov/pubmed/37588629
http://dx.doi.org/10.1016/j.xrrt.2020.11.007
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