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ORIF of Intraarticular Fractures of Distal Humerus with LCP Biplanar Plating

Dimitar Dimitrov, Valentin Dimitrov, Ivaylo Minev, Veronika Zhelezova, Dimitar Raikov

Abstract

Introduction: Intraarticular fractures of the distal humerus are relatively rare, most frequently occurring in people in their forties. The mechanism is either a low-energy trauma, when direct hit on the elbow occurs due to a fall in the forward direction, or high-energy ones. Clinical symptoms include pain, swelling, impaired movement and disfiguration of the elbow. Standard anteroposterior and lateral radiographs of the elbow are usually sufficient for diagnosis. The AO/OTA classification is based on the fracture line location and the degree of articular involvement. These intraarticular traumas are termed as type C fracture (AO classification).

Materials and Methods: During the period 2015-2017 a total of 18 of patients were admitted with distal humeral fractures. Five of them (28%) were with type C – intraarticular fractures. In all cases open reduction and internal fixation was performed. We used posterior transolecranial approach and chevron-shaped olecranon osteotomy. Once the articular surface is exposed the fracture haematoma is evacuated, and all free fragments are removed. K-wires were placed through the medial and the lateral segments to provide provisional fixation. Definitive reduction and fixation was done using biplanar plating with anatomically precontoured LCP.

Results: We used Broberg and Morrey rating scale for evaluation. There were 3 patients with excellent score, 1 good, 1 fair. The mean lack of extension was 8°, mean flexion - 130°, prono-supination was reduced to 155°, with prevalence of pronation. There were no patients with early  radiograph signs of arthrosis or osteonecrosis.

Conclusion: The elbow joint is inherently prone to stiffness. The functional outcomes are in correlation with the achieved anatomic reduction and stable fixation, while avoiding prolonged immobilization. Using biplanar LCP gives better mechanical resistance, higher stability, and fragment compression, in comparison to uniplanar plating or non-locking plates. Thus, resulting in shorter immobilization, earlier rehabilitation and regaining full range of elbow motion.


Keywords

distal humerus, LCP, ORIF


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