title: The use of hinged external fixation to provide additional stabilization for fractures of the distal humerus.
abstract: OBJECTIVE
  To assess improvements in fixation stability when a hinged unilateral external fixator is used to supplement compromised internal fixation for distal humerus fractures.
  
  
  METHODS
  Removing a 1-cm section of the distal humerus in cadaveric whole-arm specimens created a comminuted distal humerus fracture model (AO type 13-A3). Fixation was then performed using different constructs representing optimal, compromised, or supplemented internal fixation. Internal fixation consisted of either 2 reconstruction plates with 1, 2, or 3 (optimal) distal attachment screws, or crossing medial and lateral cortical screws. A hinged external fixator was applied in combination with compromised internal fixation. The stability of the different constructs was then evaluated using 3-point bending stiffness and distal fragment displacement measurements during flexion and extension testing.
  
  
  RESULTS
  Addition of the external fixator increased the stiffness of all constructs. Stiffness of the compromised reconstruction plate constructs with supplemented fixation was similar to or significantly greater than that of optimal internal fixation. Addition of the fixator to the reconstruction plates with 1 screw or the crossing screws produced displacements of the distal fragment that were similar to those of the compromised constructs alone. However, medial/lateral and anterior/posterior displacements of the distal fragment during flexion and extension of the elbow for supplemented fixation were found to be greater than those for optimal internal fixation.
  
  
  CONCLUSIONS
  The use of a hinged external fixator for supplemental fixation of distal humerus fractures may be effective in cases where internal fixation is severely compromised, although displacements may increase above optimal fixation.
authors.affiliation: Department of Mechanical and Aeronautical Engineering, University of California, Davis, California, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Deuel
authors.forename: Philip
authors.initials: P
authors.lastname: Wolinsky
authors.forename: Eric
authors.initials: E
authors.lastname: Shepherd
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Hazelwood
mesh_terms: D016267:External Fixators; D005593:Fracture Fixation, Internal / Q000379:methods*; D018460:Fractures, Comminuted / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D000092464:Elbow Injuries