title: Fixation of extra-articular distal humeral fractures with a lateral approach and a locked plate: an alternative method.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the efficacy of lateral approach and anterolateral anatomical locked plate fixation on clinical and radiological healing of extra-articular distal humeral fractures.
  
  
  METHODS
  Twenty-three (17 male, 6 female) consecutive patients who underwent surgical management for closed extra-articular comminuted distal humeral fractures between 2006 and 2013 were included in this study. Anterolateral fixation with an anatomical locked plate using a lateral approach was preferred. Mean age was 34 years (range: 17-56 years). AO Foundation/American Orthopaedic Trauma Association (AO/OTA) classification was used; all patients had AO/OTA 12-B1.3 type fractures. Inclusion criteria were patients with polytrauma, late-onset radial nerve injury, and unsatisfactory closed reduction. Patients were followed up at postoperative weeks 6, 12, and 24, and in 3-month intervals thereafter. Mean follow-up period was 16 months (range: 14-18 months). Functional results were evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) score, visual analog scale (VAS) score, and Mayo elbow performance score.
  
  
  RESULTS
  Mean flexion was 135° (range: 128-140°) at 24 weeks postoperatively; there was no loss of pronation and supination of the forearm. All fractures healed uneventfully in an average of 19.3 weeks (range: 16-24 weeks). Mean Mayo elbow performance score and DASH score at 24 weeks improved from 66.6 (range: 50-85) to 100 and from 53.6 (range: 25.75-80.75) to 12.7 (range: 5-26.5), respectively. VAS score at 24 weeks improved from 4 (range: 3-5) to 0.5 (range: 0-1). Postoperative radial nerve paralysis and infection were not observed.
  
  
  CONCLUSIONS
  We recommend anterolateral anatomical locked plate fixation using a lateral approach as an alternative method in the management of distal humeral extra-articular fractures. This enables rigid fixation of the distal fragment without interfering and impinging on the olecranon fossa, allows early active range of elbow motion, and avoids iatrogenic triceps muscle injury and radial nerve exposure, which prevents surgical radial nerve injury.
authors.affiliation: Gaziosmanpaşa Taksim Training and Research Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
authors.forename: Atilla Sancar
authors.initials: AS
authors.lastname: Parmaksızoğlu
authors.affiliation: Gaziosmanpaşa Taksim Training and Research Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
authors.forename: Ufuk
authors.initials: U
authors.lastname: Özkaya
authors.affiliation: İstanbul University İstanbul Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
authors.forename: Fuat
authors.initials: F
authors.lastname: Bilgili
authors.affiliation: Gaziosmanpaşa Taksim Training and Research Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
authors.forename: Harun
authors.initials: H
authors.lastname: Mutlu
authors.affiliation: Gaziosmanpaşa Taksim Training and Research Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
authors.forename: Ümit
authors.initials: Ü
authors.lastname: Çetin
mesh_terms: D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D004185:Disability Evaluation; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D018460:Fractures, Comminuted / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D014421:Turkey; D055815:Young Adult