Gupta Rakesh Kumar, Gupta Vinay, Marak Dickey Richard
Department of Orthopaedics, Physical Medicine, Paraplegia and Rehabilitation, Pt. BD Sharma Post Graduate Institute of Medical Sciences, Rohtak 124001, India.
Chin J Traumatol. 2013;16(4):207-11.
The treatment of multi-fragmentary, intraarticular fractures of the distal humerus is difficult, even in young patients with bone of good quality. Small distal fragment, diminished bone mineral quality and increased trauma-associated joint destruction make stable joint reconstruction more problematic. The anatomically preshaped locking plates allow angular stable fixation for these complex fractures. We evaluated functional results of patients treated with open reduction and internal fixation with distal humerus locking plates for complex distal humerus fractures.
Forty-three consecutive patients with articular fractures of the distal humerus were treated by open reduction and internal fixation with AO distal humerus plate system and locking reconstruction plates. Forty patients were available for the final outcome analysis. According to AO/ASIF classification, there were 2 cases of type A2, 4 cases of type A3, 1 case of type B1, 1 case of type B2, 14 cases of type C1, 7 cases of type C2 and 11 cases of type C3. Open reduction with triceps splitting technique was used in all patients. The clinical and radiographic follow-up was performed and outcome measures included pain assessment, range of motion, and Mayo elbow performance score.
Forty patients were available for the final outcome analysis. There were 29 males and 11 females with an average age of 38.4 years (18-73 years). Clinical and radiological consolidation of the fracture was observed in all cases at an average of 11.6 weeks (9-14 weeks). The average follow-up was 12 months (10-18 months). Using the Mayo elbow performance score the results obtained were graded as excellent or good results in 33 patients (82.5%). One patient had superficial infection, and 4 had myositis ossificans. There were no cases of primary malposition or secondary displacement, implant failure or ulnar neuropathy.
Anatomically preshaped distal humerus locking plate system is useful in providing stable fixation for complex distal articular fracture and facilitating early postoperative rehabilitation. The low rate of implant failure in the present study indicates that the technique is promising and warrants further investigation.
肱骨远端多片段关节内骨折的治疗颇具难度，即便对于骨质良好的年轻患者亦是如此。远端小骨块、骨矿物质质量下降以及创伤相关的关节破坏增加，使得稳定的关节重建更具问题。解剖预塑形锁定钢板可为这些复杂骨折提供角稳定固定。我们评估了采用肱骨远端锁定钢板切开复位内固定治疗复杂肱骨远端骨折患者的功能结果。
连续43例肱骨远端关节骨折患者接受了采用AO肱骨远端钢板系统和锁定重建钢板的切开复位内固定治疗。40例患者可进行最终结果分析。根据AO/ASIF分类，A2型2例，A3型4例，B1型1例，B2型1例，C1型14例，C2型7例，C3型11例。所有患者均采用三头肌劈开技术进行切开复位。进行了临床和影像学随访，结果指标包括疼痛评估、活动范围和梅奥肘关节功能评分。
40例患者可进行最终结果分析。其中男性29例，女性11例，平均年龄38.4岁（18 - 73岁）。所有病例骨折均在平均11.6周（9 - 14周）实现临床和影像学愈合。平均随访12个月（10 - 18个月）。采用梅奥肘关节功能评分，33例患者（82.5%）结果为优或良。1例患者发生表浅感染，4例发生骨化性肌炎。无原发位置异常或继发移位、植入物失败或尺神经损伤病例。
解剖预塑形肱骨远端锁定钢板系统有助于为复杂的远端关节骨折提供稳定固定，并促进术后早期康复。本研究中植入物失败率较低，表明该技术前景良好，值得进一步研究。
