Shin Sang-Jin, Kwak Ji-Woong, Sohn Hoon-Sang
Department of Orthopaedic Surgery, Ewha Shoulder Disease Center, Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 162 Ilsan-dong, Wonju, 26426, Korea.
Int Orthop. 2022 Sep;46(9):2119-2126. doi: 10.1007/s00264-022-05435-9. Epub 2022 May 16.
The ideal surgical treatment of extra-articular distal-third diaphyseal humeral fractures is controversial in terms of the surgical approach and plate position. The aim of this study was to compare the clinical and radiological outcomes between anterior and posterior plating methods for extra-articular distal-third diaphyseal humeral fractures.
Twenty-four patients were treated with anterior plating with modified placement of the proximal humeral internal locking system (PHILOS) plate, and 22 patients were treated with posterior plating of the extra-articular distal humerus plate (EADHP). Patient demographics, the fracture configuration, the number of screws in the distal fragment, the operation time, and the time to union were analyzed. The range of elbow motion, Mayo elbow performance score (MEPS), plate-related symptoms, and complications were evaluated at the final follow-up.
There were no statistically significant differences in the demographic data between the two groups. The mean operation time for anterior plating (108.2 ± 24.5 min) was significantly shorter than that for posterior plating (144.2 ± 29.5 minutes, p < 0.001). The average number of screws used in the distal humeral fragment was significantly higher with anterior plating (5.7 ± 0.7) than with posterior plating (4.8 ± 0.5, p < 0.001). No patients in the anterior plating group had plate-related symptoms, while 17 patients in the posterior plating group (77%) had discomfort or cosmetic problems related to the plate (p < 0.001). Plate removal was performed upon patient request in nine patients of the posterior plating (52.9%) and four (17%) in anterior plating (p = 0.040). Nonunion occurred in one patient who underwent anterior plating, and one patient who underwent posterior plating had post-operative radial nerve palsy. There were no significant differences in the MEPS or elbow range of motion between the two surgical methods.
Both anterior and posterior plating provide satisfactory clinical and radiologic outcomes for extra-articular distal-third diaphyseal humeral fractures. Despite the satisfactory outcomes, however, posterior plating is highly associated with plate-related complaints, which might be one of the considerations when the surgical method is selected for extra-articular distal-third diaphyseal humeral fractures.
在手术入路和钢板位置方面，肱骨远端干骺端关节外骨折的理想手术治疗存在争议。本研究的目的是比较肱骨远端干骺端关节外骨折采用前路钢板固定和后路钢板固定方法后的临床和影像学结果。
24例患者采用改良肱骨近端内锁定系统（PHILOS）钢板前路固定治疗，22例患者采用肱骨远端关节外钢板（EADHP）后路固定治疗。分析患者人口统计学资料、骨折形态、远端骨折块螺钉数量、手术时间和愈合时间。在末次随访时评估肘关节活动范围、梅奥肘关节功能评分（MEPS）、与钢板相关的症状及并发症。
两组患者的人口统计学数据无统计学显著差异。前路钢板固定的平均手术时间（108.2±24.5分钟）明显短于后路钢板固定（144.2±29.5分钟，p<0.001）。肱骨远端骨折块使用螺钉的平均数量，前路钢板固定（5.7±0.7）明显多于后路钢板固定（4.8±0.5，p<0.001）。前路钢板固定组无患者出现与钢板相关的症状，而后路钢板固定组有17例患者（77%）出现与钢板相关的不适或外观问题（p<0.001）。9例（52.9%）后路钢板固定患者和4例（17%）前路钢板固定患者根据患者要求取出了钢板（p=0.040）。1例接受前路钢板固定的患者发生骨不连，1例接受后路钢板固定的患者术后出现桡神经麻痹。两种手术方法在MEPS或肘关节活动范围方面无显著差异。
对于肱骨远端干骺端关节外骨折，前路和后路钢板固定均能提供满意的临床和影像学结果。然而，尽管结果令人满意，但后路钢板固定与钢板相关的问题高度相关，这可能是选择肱骨远端干骺端关节外骨折手术方法时需要考虑的因素之一。
