Barret Hugo, Ceccarelli Romain, D'Allais Paul Vial, Winter Matthias, Chammas Michel, Coulet Bertrand, Lazerges Cyril
CHRU de Montpellier, Montpellier, France.
CHU de Nice, Nice, France.
Orthop Traumatol Surg Res. 2023 Sep;109(5):103380. doi: 10.1016/j.otsr.2022.103380. Epub 2022 Jul 29.
There is no "gold standard" for the type of plate to be used for distal extra-articular humeral fractures; the most used is plating of each column. The objective was to evaluate the short-term clinical and radiological results of a Y- anatomical and innovative locking plate (YALP).
The hypothesis is: this anatomical and innovative locking plate will produce satisfactory and reliable results on extra-articular distal humerus fracture superior to double plate fixation.
In a retrospective observational multicenter study, all patients with a distal humerus fracture type 13 A2.2 according to AO classification fixed with a new Y-plate (YALP) were compared to the results of double plate fixation for the same type of fracture. With a follow-up of more than 12 months, the objective and subjective clinical elbow criteria as well as the overall function of the upper limb and radiological assessment were collected.
With an average follow up of 24±11 months, 26 patients met the inclusion criteria and received a YALP and 24 patients received double plate. All patients whose fracture had healed except one were pain-free (mean VAS 0.3±0.6). All patients had good subjective results (mean SEV 96%±4). Elbow function was excellent (mean total MEPS 96±4) with normal triceps strength (23/24 patients had a triceps strength graded 5/5 and one patient 4/5) and range of motion (flexion 139±8, extension -7±8 and pronosupination greater than 155 degrees). The operating time was shorter in the YALP group (84 ± 23minutes versus 97 ± 28minutes, p=0.03). The double plate group had more complications; the overall complication rate was significantly higher (p=0.02) in the double 90-degree plate group (12/24, 50%) with four nonunions, four symptomatic ulnar nerves, three hardware removals for pain and one radial nerve injury versus 5/26 complications (19%, p=0.02) in the Y-plate group: one iliac graft for nonunion, 1 plate removal due to functional discomfort, 1 twisted YALP, 1 broke interfragmentary screw and one symptomatic ulnar nerve. DASH, SEV, MEPS scores and flexion-extension range were better in the YALP group.
YALP produces satisfactory results in supracondylar fractures of the distal humerus. The results of YALP appear to be better than the results with two 90° plates for the same fracture type with a shorter operative time and easier management of fractures with proximal diaphyseal extension.
III; case control study.
对于肱骨远端关节外骨折所使用的钢板类型，目前尚无“金标准”；最常用的是对每一列进行钢板固定。目的是评估一种Y形解剖型创新锁定钢板（YALP）的短期临床和放射学结果。
假设为：这种解剖型创新锁定钢板在肱骨远端关节外骨折上能产生优于双钢板固定的满意且可靠的结果。
在一项回顾性观察性多中心研究中，将所有根据AO分类为13 A2.2型的肱骨远端骨折且采用新型Y形钢板（YALP）固定的患者与同一类型骨折采用双钢板固定的结果进行比较。随访时间超过12个月，收集客观和主观的临床肘部标准以及上肢的整体功能和放射学评估结果。
平均随访24±11个月，26例患者符合纳入标准并接受了YALP治疗，24例患者接受了双钢板治疗。除1例患者外，所有骨折已愈合的患者均无疼痛（平均视觉模拟评分[VAS]为0.3±0.6）。所有患者主观结果良好（平均患者满意度[SEV]为96%±4）。肘部功能优秀（平均总梅奥肘关节功能评分[MEPS]为96±4），三头肌力量正常（23/24例患者三头肌力量评分为5/5，1例患者为4/5），活动范围（屈曲139±8°，伸展-7±8°，旋前旋后大于155°）。YALP组的手术时间较短（84±23分钟对97±28分钟，p = 0.03）。双钢板组并发症更多；双90°钢板组的总体并发症发生率显著更高（p = 0.02）（12/24，50%），包括4例骨不连、4例症状性尺神经损伤、3例因疼痛取出内固定物和1例桡神经损伤，而Y形钢板组有5/26例并发症（19%，p = 0.02）：1例因骨不连进行髂骨移植、1例因功能不适取出钢板、1例YALP扭曲、1例骨折块间螺钉断裂和1例症状性尺神经损伤。YALP组的上肢功能障碍评分（DASH）、患者满意度（SEV）、梅奥肘关节功能评分（MEPS）以及屈伸范围更好。
YALP在肱骨远端髁上骨折中产生了满意的结果。对于同一骨折类型，YALP的结果似乎优于双90°钢板，手术时间更短，对于伴有近端骨干延伸的骨折处理更容易。
III级；病例对照研究。
