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Complex Distal Humeral Fractures: Internal Fixation with a Principle-Based Parallel-Plate Technique

Surgical Technique

¹ Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Medical Sciences Building 3-69, Rochester, MN 55905. E-mail address for S.W. O'Driscoll: odriscoll.shawn{at}mayo.edu

Investigation performed at the Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 89-A, pp. 961-9, May 2007

DISCLOSURE: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Acumed). Also, a commercial entity (Acumed) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated. One of the authors works with Stryker on implant design.

A video supplement to this article will be available from the Video Journal of Orthopaedics. A video clip will be available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

METHODS: Thirty-four consecutive complex distal humeral fractures were fixed with two parallel plates applied (medially and laterally) in approximately the sagittal plane. The technique was specifically designed to satisfy two principles: (1) fixation in the distal fragments should be maximized and (2) screw fixation in the distal segment should contribute to stability at the supracondylar level. Twenty-six fractures were AO type C3, and fourteen were open. Thirty-two fractures were followed for a mean of two years. The patients were assessed clinically with use of the Mayo Elbow Performance Score (MEPS) and radiographically.

RESULTS: Neither hardware failure nor fracture displacement occurred in any patient. Union of thirty-one of the thirty-two fractures was achieved primarily. Five patients underwent additional surgery to treat elbow stiffness. There was one deep infection that resolved without hardware removal and did not impede union. At the time of the most recent follow-up, twenty-eight elbows were either not painful or only mildly painful, and the mean flexion-extension arc was 99°. The mean MEPS was 85 points. The result was graded as excellent for eleven elbows, good for sixteen, fair for two, and poor for three.

CONCLUSIONS: Stable fixation and a high rate of union of complex distal humeral fractures can be achieved when a principle-based surgical technique that maximizes fixation in the distal segments and stability at the supracondylar level is employed. The early stability achieved with this technique permits intensive rehabilitation to restore elbow motion.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

ORIGINAL ABSTRACT CITATION: "Complex Distal Humeral Fractures: Internal Fixation with a Principle-Based Parallel-Plate Technique" (2007;89:961-9).

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