Complex Articular Fractures of the Distal Humerus. Recommendations to Optimize Outcomes and Reduce Complications
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Published:
Apr 18, 2022
Keywords:
Fractures, distal humerus, planning, osteosynthesis
Main Article Content
Abstract
Complex articular fractures of the distal humerus represent a real challenge for orthopedic surgeons. The complexity of the anatomy, fracture patterns, the presence of multiple fragments, and low bone density in the elderly represent some difficulties to address. The relatively low frequency of these fractures directly undermines training and systematization of the surgical procedure and therefore has an impact on the final functional outcome and complication rate. The aim of this article is to provide practical tools to the novel surgeon, through the review of the literature and the author´s experience, to reduce complications and optimize the treatment of these fractures.
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How to Cite
Maiorano, M., Argüelles, S., Pereira, E., & Zaidenberg, C. (2022). Complex Articular Fractures of the Distal Humerus. Recommendations to Optimize Outcomes and Reduce Complications. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(2), 259-272. https://doi.org/10.15417/issn.1852-7434.2022.87.2.1477
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Artículo Especial
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References
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dysfunction in type C fractures of distal humerus. J Trauma 2009;67(6):1397-401.
https://doi.org/10.1097/TA.0b013e3181968176
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Orthop 2018;42(11):2653-62. https://doi.org/10.1007/s00264-017-3719-4
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randomized, controlled trial of open reduction—internal fixation versus total elbow arthroplasty for displaced intraarticular distal humeral fractures in elderly patients. J Shoulder Elbow Surg 2009;18(1):3-12.
https://doi.org/10.1016/j.jse.2008.06.005
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elbow: a simple method of comparison of the articular exposure. Surg Radiol Anat 2007;29(8):671-4.
https://doi.org/10.1007/s00276-007-0263-8
10. Ljungquist KL, Beran MC, Awan H. Effects of surgical approach on functional outcomes of open reduction
and internal fixation of intra-articular distal humeral fractures: a systematic review. J Shoulder Elbow Surg 2012;21(1):126-35. https://doi.org/10.1016/j.jse.2011.06.020
11. Taylor PA, Owen JR, Benfield CP, Wayne JS, Boardman ND. Parallel plating of simulated distal humerus fractures demonstrates increased stiffness relative to orthogonal plating with a distal humerus locking plate system. J Orthop Trauma 2016;30(4):e118-22. https://doi.org/10.1097/BOT.0000000000000477
12. Atalar AC, Tunalı O, Erşen A, Kapıcıoğlu M, Sağlam Y, Demirhan MS. Biomechanical comparison of orthogonal
versus parallel double plating systems in intraarticular distal humerus fractures. Acta Orthop Traumatol Turc
2017;51(1):23-8. https://doi.org/10.1016/j.aott.2016.11.001
13. Lee SK, Kim KJ, Park KH, Choy WS. A comparison between orthogonal and parallel plating methods for distal
humerus fractures: a prospective randomized trial. Eur J Orthop Surg Traumatol 2013;24(7):1123-31.
https://doi.org/10.1007/s00590-013-1286-y
14. Wang X, Liu G. A comparison between perpendicular and parallel plating methods for distal humerus fractures. Medicine (Baltimore) 2020;99(23):e19602. https://doi.org/10.1097/MD.0000000000019602
15. Sanchez-Sotelo J, Torchia ME, O’Driscoll SW. Complex distal humeral fractures: internal fixation with a principlebased parallel-plate technique. J Bone Joint Surg Am 2008;90(Suppl 2 Pt 1):31-46. https://doi.org/10.2106/JBJS.G.01502
16. Shearin JW, Chapman TR, Miller A, Ilyas AM. Ulnar nerve management with distal humerus fracture fixation. Hand Clin 2018;34(1):97-103. https://doi.org/10.1016/j.hcl.2017.09.010
17. Worden A, Ilyas AM. Ulnar neuropathy following distal humerus fracture fixation. Orthop Clin North Am
2012;43(4):509-14. https://doi.org/10.1016/j.ocl.2012.07.019
epidemiology and results of treatment. J Orthop Trauma 2003;17(1):38-47. https://doi.org/10.1097/00005131-200301000-00006
2. Galano GJ, Ahmad CS, Levine WN. Current treatment strategies for bicolumnar distal humerus fractures. J Am
Acad Orthop Surg 2010;18(1):20-30. https://doi.org/10.5435/00124635-201001000-00004
3. Ring D, Jupiter JB. Fractures of the distal humerus. Orthop Clin North Am 2000;31(1):103-13.
https://doi.org/10.1016/s0030-5898(05)70131-0
4. Aitken SA, Jenkins PJ, Rymaszewski L. Revisiting the ‘bag of bones’: functional outcome after the conservative
management of a fracture of the distal humerus. Bone Joint J 2015;97-B(8):1132-8. https://doi.org/10.1302/0301-620X.97B8.35410
5. Ruan H-J, Liu J-J, Fan C-Y, Jiang J, Zeng B-F. Incidence, management, and prognosis of early ulnar nerve
dysfunction in type C fractures of distal humerus. J Trauma 2009;67(6):1397-401.
https://doi.org/10.1097/TA.0b013e3181968176
6. Zalavras CG, Papasoulis E. Intra-articular fractures of the distal humerus—a review of the current practice. Int
Orthop 2018;42(11):2653-62. https://doi.org/10.1007/s00264-017-3719-4
7. Hausman M, Panozzo A. Treatment of distal humerus fractures in the elderly. Clin Orthop Relat Res 2004;425:55-63. https://doi.org/10.1016/s1551-7977(08)70054-2
8. McKee MD, Veillette CJH, Hall JA, Schemitsch EH, Wild LM, McCormack R, et al. A multicenter, prospective,
randomized, controlled trial of open reduction—internal fixation versus total elbow arthroplasty for displaced intraarticular distal humeral fractures in elderly patients. J Shoulder Elbow Surg 2009;18(1):3-12.
https://doi.org/10.1016/j.jse.2008.06.005
9. Dakouré PWH, Ndiaye A, Ndoye J-M, Sané AD, Niane MM, Séye SIL, et al. Posterior surgical approaches to the
elbow: a simple method of comparison of the articular exposure. Surg Radiol Anat 2007;29(8):671-4.
https://doi.org/10.1007/s00276-007-0263-8
10. Ljungquist KL, Beran MC, Awan H. Effects of surgical approach on functional outcomes of open reduction
and internal fixation of intra-articular distal humeral fractures: a systematic review. J Shoulder Elbow Surg 2012;21(1):126-35. https://doi.org/10.1016/j.jse.2011.06.020
11. Taylor PA, Owen JR, Benfield CP, Wayne JS, Boardman ND. Parallel plating of simulated distal humerus fractures demonstrates increased stiffness relative to orthogonal plating with a distal humerus locking plate system. J Orthop Trauma 2016;30(4):e118-22. https://doi.org/10.1097/BOT.0000000000000477
12. Atalar AC, Tunalı O, Erşen A, Kapıcıoğlu M, Sağlam Y, Demirhan MS. Biomechanical comparison of orthogonal
versus parallel double plating systems in intraarticular distal humerus fractures. Acta Orthop Traumatol Turc
2017;51(1):23-8. https://doi.org/10.1016/j.aott.2016.11.001
13. Lee SK, Kim KJ, Park KH, Choy WS. A comparison between orthogonal and parallel plating methods for distal
humerus fractures: a prospective randomized trial. Eur J Orthop Surg Traumatol 2013;24(7):1123-31.
https://doi.org/10.1007/s00590-013-1286-y
14. Wang X, Liu G. A comparison between perpendicular and parallel plating methods for distal humerus fractures. Medicine (Baltimore) 2020;99(23):e19602. https://doi.org/10.1097/MD.0000000000019602
15. Sanchez-Sotelo J, Torchia ME, O’Driscoll SW. Complex distal humeral fractures: internal fixation with a principlebased parallel-plate technique. J Bone Joint Surg Am 2008;90(Suppl 2 Pt 1):31-46. https://doi.org/10.2106/JBJS.G.01502
16. Shearin JW, Chapman TR, Miller A, Ilyas AM. Ulnar nerve management with distal humerus fracture fixation. Hand Clin 2018;34(1):97-103. https://doi.org/10.1016/j.hcl.2017.09.010
17. Worden A, Ilyas AM. Ulnar neuropathy following distal humerus fracture fixation. Orthop Clin North Am
2012;43(4):509-14. https://doi.org/10.1016/j.ocl.2012.07.019