Management of comminuted fractures of the distal humerus: clinical outcome after primary external fixation versus immediate fixation with locking plates.

OBJECTIVES

The surgical treatment of comminuted fractures of the distal humerus remains a challenging problem. The aim of the present study was to compare the clinical outcomes of primary external fixation with second-staged open reduction and internal fixation (ORIF) and initial definitive internal fixation in surgically treated patients with comminuted distal humerus fractures.

DESIGN

Retrospective comparative study.

SETTING

Level one trauma center.

PATIENTS: A total of 24 patients (median age 52 years; range 14-84 years) were included: 15 patients were treated with initial definitive internal fixation with pre-contoured locking compression plates (group A), and 9 patients underwent surgical treatment with primary external fixation and second-staged ORIF (group B). Only patients with C3 fractures according to the AO classification were included in the study.

MAIN OUTCOME MEASUREMENT: Disability of the Arm, Shoulder and Hand (DASH) and Mayo Elbow Performance Score (MEPS).

INTERVENTION: External fixation internal fixation with locking plates.

RESULTS

The median follow-up was 37 months for both groups. There was a significantly higher median elbow extension deficit in group B (39°) compared to group A (17°) (p = 0.048). The mean DASH score in group A was 14 and 12.5 in group B. MEPS showed that more patients in group A achieved excellent results; however, there was no significant difference compared to group B.

CONCLUSIONS

Primary external fixation with second-staged ORIF demonstrated a higher complication rate and significantly greater loss of extension compared with initial definitive internal fixation. Thus, the use of primary external fixation in cases of comminuted distal humerus fractures appears to have a negative influence on the patient outcomes.

LEVEL OF EVIDENCE: Therapeutic level III.