ALİ ÇAĞDAŞ YÖRÜKOĞLU, AHMET FAHİR DEMİRKAN, Nihal BÜKER

Distal medial tibial locking plate for fixation of extraarticular distal humeral fractures; an alternative choice for fixation

Objective: The aim of this study was to describe an alternative fixation method for distal humeral extraarticularfractures through posterior approach using distal tibia anatomic locking plate; and to evaluatethe patient's functional outcome and union condition.Methods: Eighteen patients (11 men and 7 women; average age of 37.0 ± 17.3 years (range: 18e73 years))with a distal humeral extra-articular fracture who were treated with distal tibial medial locking platewere included into the study. The mean follow up time was 36.2 ± 16.7 (12e57) months. Functionalresults were evaluated with perception of pain, range of joint motion, grasp and pinch strengths.Results: Union was achieved in 17 of 18 patients. Only one patient had non-union due to infection andunderwent debridement. The mean time for union was 7.8 ± 5.9 months (2e20). Patient perception ofpain was X ¼ 1.88 ± 2.50 and X ¼ 4.55 ± 2.68, respectively, at rest and activity. The active ranges of jointmotion were adequate for functional use. General functional state of affected extremity (DASH-T) wasperfect (X ¼ 27.14 ± 25.66), the performance of elbow joint was good (X ¼ 84.44 ± 11.57). There were nodifferences in the comparison of grasp and pinch grip of patients with uninvolved extremity (p > 0.05).Conclusions: In distal humeral extra-articular fractures, use of distal medial tibia plate has advantagessuch as providing high rates for union, low rates for complication, and early return to work with earlyrehabilitation, therefore it may be considered a fixation choice that can be used for distal humeral extraarticularfractures

___

Tsai CH, Fong YC, Chen YH, Hsu CJ, Chang CH, Hsu HC. The epidemiology of traumatic humeral shaft fractures in Taiwan. Int Orthop. 2009;33(2):463e467. https://doi.org/10.1007/s00264-008-0537-8.

Elton SG, Rizzo M. Management of radial nerve injury associated with humeral shaft fractures: an evidence-based approach. J Reconstr Microsurg. 2008;24(8): 569e573. https://doi.org/10.1055/s-0028-1090623.

Ouyang H, Xiong J, Xiang P, Cui Z, Chen L, Yu B. Plate versus intramedullary nail fixation in the treatment of humeral shaft fractures: an updated meta-analysis. J Shoulder Elbow Surg. 2013;22(3):387e395. https://doi.org/10.1016/ j.jse.2012.06.007.

Bleeker WA, Nijsten MW, ten Duis HJ. Treatment of humeral shaft fractures related to associated injuries. A retrospective study of 237 patients. Acta Orthop Scand. 1991;62(2):148e153. https://doi.org/10.3109/17453679108999244.

Walker M, Palumbo B, Badman B, Brooks J, Van Gelderen J, Mighell M. Humeral shaft fractures: a review. J Shoulder Elbow Surg. 2011;20(5):833e844. https:// doi.org/10.1016/j.jse.2010.11.030.

Prasarn ML, Ahn J, Paul O, et al. Dual plating for fractures of the distal third of the humeral shaft. J Orthop Trauma. 2011;25(1):57e63. https://doi.org/ 10.1097/BOT.0b013e3181df96a7.

Holdsworth BJ, Mossad MM. Fractures of the adult distal humerus. Elbow function after internal fixation. J Bone Joint Surg Br. 1990;72(3):362e365. https://doi.org/10.1302/0301-620X.72B3.2341427.

Huang TL, Chiu FY, Chuang TY, Chen TH. Surgical treatment of acute displaced fractures of adult distal humerus with reconstruction plate. Injury. 2004;35(11):1143e1148. https://doi.org/10.1016/j.injury.2003.11.018.

Jupiter JB, Neff U, Holzach P, Allgower M. Intercondylar fractures of the hu- € merus. An operative approach. J Bone Joint Surg Am. 1985;67(2):226e239.

Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17(1):45e56. https://doi.org/10.1016/0304-3959(83)90126-4.

Tejwani NC, Murthy A, Park J, McLaurin TM, Egol KA, Kummer FJ. Fixation of extra-articular distal humerus fractures using one locking plate versus two reconstruction plates: a laboratory study. J Trauma. 2009;66(3):795e799. https://doi.org/10.1097/TA.0b013e318181e53c.

Ilyas AM, Jupiter JB. Treatment of distal humerus fractures. Acta Chir Orthop Traumatol Cech. 2008;75(1):6e15.

Jeong BO, Lee DK. Treatment for type C fractures of the distal humerus with the LCP distal humerus system. Eur J Orthop Surg Traumatol. 2012;22(7):565e569. https://doi.org/10.1007/s00590-011-0893-8.

Kharbanda Y, Tanwar YS, Srivastava V, Birla V, Rajput A, Pandit R. Retrospective analysis of extra-articular distal humerus shaft fractures treated with the use of pre-contoured lateral column metaphyseal LCP by triceps-sparing posterolateral approach. Strateg Trauma Limb Reconstr. 2017;12(1):1e9. https://doi.org/ 10.1007/s11751-016-0270-6.

Meloy GM, Mormino MA, Siska PA, Tarkin IS. A paradigm shift in the surgical reconstruction of extra-articular distal humeral fractures: single-column plating. Injury. 2013;44(11):1620e1624. https://doi.org/10.1016/j.injury .2013.07.005.

Chen RC, Harris DJ, Leduc S, Borrelli JJ, Tornetta P, Ricci WM. Is ulnar nerve transposition beneficial during open reduction internal fixation of distal humerus fractures? J Orthop Trauma. 2010;24(7):391e394. https://doi.org/ 10.1097/BOT.0b013e3181c99246.

Vazquez O, Rutgers M, Ring DC, Walsh M, Egol KA. Fate of the ulnar nerve after operative fixation of distal humerus fractures. J Orthop Trauma. 2010;24(7): 395e399. https://doi.org/10.1097/BOT.0b013e3181e3e273.

Jawa A, McCarty P, Doornberg J, Harris M, Ring D. Extra-articular distal-third diaphyseal fractures of the humerus. A comparison of functional bracing and plate fixation. J Bone Jt Surg Am. 2006;88(11):2343e2347. https://doi.org/ 10.2106/JBJS.F.00334.

Bell MJ, Beauchamp CG, Kellam JK, et al. The results of plating humeral shaft fractures in patients with multiple injuries. The Sunnybrook experience. J Bone Joint Surg Br. 1985;67(2):293e296. https://doi.org/10.1302/0301- 620X.67B2.3980544.

Yang Q, Wang F, Wang Q, et al. Surgical treatment of adult extra-articular distal humeral diaphyseal fractures using an oblique metaphyseal locking compression plate via a posterior approach. Med Princ Pract. 2012;21(1):40e45. https:// doi.org/10.1159/000331791.

Levy JC, Kalandiak SP, Hutson JJ, Zych G. An alternative method of osteosynthesis for distal humeral shaft fractures. J Orthop Trauma. 2005;19(1):43e47. https://doi.org/10.1097/00005131-200501000-00008.

parmaksızoglu AS, Ozkaya U, Bilgili F, Mutlu H, Çetin Ü. Fixation of extra- € articular distal humeral fractures with a lateral approach and a locked plate: an alternative method. Acta Orthop Traumatol Turc. 2016;50(2):132e138. https://doi.org/10.3944/AOTT.2015.14.0445.

Sabalic S, Kodvanj J, Pavic A. Comparative study of three models of extraarticular distal humerus fracture osteosynthesis using the finite element method on an osteoporotic computational model. Injury. 2013;44(suppl 3). https://doi.org/10.1016/S0020-1383(13)70200-6.

Fawi H, Lewis J, Rao P, Parfitt D, Mohanty K, Ghandour A. Distal third humeri fractures treated using the SynthesTM 3.5-mm extra-articular distal humeral locking compression plate: clinical, radiographic and patient outcome scores. Shoulder Elb. 2015;7(2):104e109. https://doi.org/10.1177/175857321 4559320.

Dunlap JT, Lucas GL, Chong AC, Cooke FW, Tiruvadi V. Biomechanical evaluation of locking plate fixation with hybrid screw constructs in analogue humeri. Am J Orthop (Belle Mead NJ). 2011;40(2):E20eE25.