Stabilisation of articular fractures of the distal humerus: early experience with a novel perpendicular plate system.
BACKGROUND
The treatment of fractures of the distal humerus is difficult and involves the risk of bad functional results, particularly with articular fractures or impaired bone quality. Anatomical reconstruction and stable fixation allowing early mobilisation of the elbow are the basic prerequisites for good clinical outcomes. The aim of our study was to evaluate whether the Distal Humerus Plate (DHP, Synthes), a novel, perpendicular, fixed-angle plate system, fulfils the requirements for this treatment goal.


METHODS
From 2004 to 2007, 46 consecutive patients (19 men and 21 women; mean age of 60.5 years) underwent open reduction and internal fixation with the new DHP system. Six patients were lost to follow up. The remaining 40 patients were followed up for 11 months (range 4-24 months). Follow up involved assessment of functional outcome using the Mayo Elbow Performance Score (MEPS) and Liverpool Elbow Score (LES), reduction results and complication rates. Subgroup analyses involved comparisons of younger (<60 years) to elderly (> or =60 years) patients and type C3 injuries versus other fracture patterns.


RESULTS
Only six cases received primary internal fixation, whilst 31 patients were temporarily stabilised by either external fixation or cast before ORIF could be performed. Three patients were treated for implant failure (systems other than DHP) after surgery in other hospitals. The mean time from injury to internal fixation was 7 days. Open fractures were present in 10 cases. Olecranon osteotomy was required for reduction in 35 cases. Mean operation time was 215 min. 'Good' or 'excellent' results were observed in 29/40 patients. Median MEPS and LES were 84 and 8.1 points, respectively. Mean ROM was 100 degrees. We found no significant differences in the subgroup analyses; however, there was a tendency towards better functional results in younger patients and injuries without comminution of the articular surface. Complications comprised two superficial wound infections, two cases of heterotopic ossification, one case of delayed union and five cases of transient ulnar neuropathy. Implant failure was observed twice in one patient.


CONCLUSIONS
Open reduction and internal fixation with the DHP system provides reliable, stable fixation allowing early functional mobilisation of the elbow joint, even in complex fractures and impaired bone quality, resulting in good outcomes for the majority of patients. The complication rate reported here is comparable to that of other implants, but the low number of implant failures is promising and warrants further investigation.
Reising
K
K
Department of Orthopedic and Trauma Surgery, Freiburg University Medical Center, Hugstetter Str. 55, D- 79106 Freiburg, Germany. kilian.reising@uniklinik-freiburg.de
Hauschild
O
O
Strohm
P C
PC
Suedkamp
N P
NP
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D018460:Fractures, Comminuted / Q000601:surgery*; D005599:Fractures, Ununited / Q000453:epidemiology; D006801:Humans; D006810:Humeral Fractures / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D056740:Olecranon Process / Q000601:surgery; D010027:Osteotomy; D011475:Prosthesis Failure; D016059:Range of Motion, Articular; D020127:Recovery of Function; D016896:Treatment Outcome; D020424:Ulnar Neuropathies / Q000209:etiology; D055815:Young Adult; D000092464:Elbow Injuries