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Anterior chondral buttress plating for complex coronal shear fractures of the distal humerus. A retrospective case series.
СтатьяНазвание и аннотация: Перевод в очереди
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Gavaskar Ashok S, Srinivasan Parthasarathy, Ayyadurai Prakash, George Bejoy P, Antony Abraham M, Jotheesvar K N
Аннотация
BACKGROUND: Internal fixation of complex coronal shear distal humerus fractures is challenged by the absence of metaphyseal osseous extension often limiting fixation strategies to intra-articular screws or wires alone. Complex injury patterns involving the entire articular surface, presence of comminution and impaction, may need additional fixation. Supplemental plating of these injuries is currently limited to the posterolateral distal humeral surface, which is biomechanically not favorable to provide an efficient buttress fixation. Anterior plating provides the best possible neutralization of the shear stresses across the fracture but run the risk of intra-articular impingement.
METHODS: Seventeen adult patients with complex coronal shear fractures classified as Dubberley type 3 in 12 patients, type 2 in 4 patients, and type 1 in 1 patient were treated with anteriorly positioned intra-articular buttress plates supplementing articular screw fixation. The primary outcome measure was loss of fracture reduction during healing. Secondary measures include plate impingement in flexion and need for removal of the plate, elbow and forearm arc of motion, and follow-up Mayo Elbow Performance Scores.
RESULTS: Fracture healing was achieved in all patients without any loss of articular fracture reduction. Four patients had demonstrable intraoperative plate impingement during flexion, of whom 3 underwent removal after fracture healing. The mean elbow flexion-extension arc was 123° (range: 100-140, standard deviation [SD]: 12), mean supination was 63° (range: 60-80, SD: 7), and mean pronation was 75° (range: 65-80, SD: 6). The mean Mayo Elbow Performance Score was 92 (range: 75-100, SD: 8) at last follow-up.
CONCLUSION: Supplemental anterior chondral buttress plating provided stable fixation for treating complex distal humerus shear fractures in the setting of articular impaction and comminution but may be associated with higher rates of hardware removal.
METHODS: Seventeen adult patients with complex coronal shear fractures classified as Dubberley type 3 in 12 patients, type 2 in 4 patients, and type 1 in 1 patient were treated with anteriorly positioned intra-articular buttress plates supplementing articular screw fixation. The primary outcome measure was loss of fracture reduction during healing. Secondary measures include plate impingement in flexion and need for removal of the plate, elbow and forearm arc of motion, and follow-up Mayo Elbow Performance Scores.
RESULTS: Fracture healing was achieved in all patients without any loss of articular fracture reduction. Four patients had demonstrable intraoperative plate impingement during flexion, of whom 3 underwent removal after fracture healing. The mean elbow flexion-extension arc was 123° (range: 100-140, standard deviation [SD]: 12), mean supination was 63° (range: 60-80, SD: 7), and mean pronation was 75° (range: 65-80, SD: 6). The mean Mayo Elbow Performance Score was 92 (range: 75-100, SD: 8) at last follow-up.
CONCLUSION: Supplemental anterior chondral buttress plating provided stable fixation for treating complex distal humerus shear fractures in the setting of articular impaction and comminution but may be associated with higher rates of hardware removal.