Outcome after open reduction and angular stable internal fixation for supra-intercondylar fractures of the distal humerus: preliminary results with the LCP distal humerus system

S Greiner, N P Haas, H J Bail
Archives of Orthopaedic and Trauma Surgery 2008, 128 (7): 723-9

INTRODUCTION: Fractures of the distal humerus are complex injuries that can be effectively treated with open reduction and internal fixation (ORIF). The new LCP distal humerus system allows angular stable fixation of these complex fractures with anatomically preshaped plates. The aim of the study was to evaluate operative reposition, fracture healing, and pain, function and patient satisfaction after open reduction with an angular stable fixation.

METHODS: Fourteen patients with a mean age of 55.2 years (21-83) were treated with open reduction and angular stable internal fixation. Two patients were lost to follow up (1 died, one refused to be reevaluated). AO classification showed 12 C-fractures (1 x C 1.1; 1 x C 1.3; 4 x C 2.2; 4 x C 3.2; 2 x C 3.3) and 2 B-fracture (B 2.3 and B 3.3). 5 fractures were open fractures (4 x II degrees , 1 x I degrees ). The clinical and radiographic follow up (Mayo elbow performance score (MEPS), Dash Score, elbow anterior-posterior and lateral view X-rays, and flexion and extension force as % of contralateral side at 90 degrees flexion) were performed postoperatively. Mean follow up was 10 months.

RESULTS: Radiographically, complete union was achieved in all patients. There were no cases of primary malposition or secondary dislocation. Complications were: (1) delayed union after olecranon osteotomy, (2) transient ulnar nerve irritation. Clinical MEPS results were good to excellent with a mean of 91 +/- 11.7 points. The mean DASH Score was 18.5 +/- 11.5 points. Mean flexion was 121 +/- 20.9, mean extension deficit was 17.9 degrees +/- 10.3. Mean flexion force was 75.3% +/- 26.7 and mean extension force was 70.7 % +/- 24.9.

CONCLUSION: Treatment of supra-intercondylar fractures of the distal humerus is challenging. Anatomically preshaped angular stable implants facilitate operative reduction and stabilization of the fracture and may allow early postoperative rehabilitation. Clinical and radiological results are promising, with good range of motion and flexion and extension force.

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