Department of Orthopaedic Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea.
Department of Orthopaedic Surgery, Hospital of Chung-Ang University of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, Korea.
Eur J Trauma Emerg Surg. 2023 Feb;49(1):125-131. doi: 10.1007/s00068-022-02064-0. Epub 2022 Aug 1.
We aimed to identify the incidence and risk factors of hardware-related complications in patients treated with anatomical locking plate fixation for extra-articular distal humerus fractures.
From 2013 to 2020, patients with extra-articular distal humerus fractures who underwent open reduction and internal fixation with an extra-articular distal humerus locking plate (EADHP) were retrospectively reviewed and categorized according to the presence/absence of hardware-related complications. Hardware-related complications were defined as the occurrence of skin prominence on the plate and discomfort in activities of daily living. Patient demographics, the lateral condylar angle, lateral body length, shaft-condylar angle of the humerus, and plate length were analyzed.
Of the 29 patients, 10 (34%) did not develop hardware-related complications (group A), whereas 19 (66%) did (group B). Patient demographics did not differ between the groups. However, the number of patients who underwent hardware removal was significantly greater in group B (16/19) than in group A (4/10; p = 0.032). Radiologic assessment revealed no significant difference in the lateral condylar or shaft-condylar angle. However, the lateral body length was greater in group A than in group B (44.5 ± 4.8 vs. 39.5 ± 3.7, p = 0.007). The plate length significantly differed between the groups. Twelve of 19 (63%) patients in group B received short-hole plates (six holes), while nine of ten (90%) patients in group A received long-hole plates (eight holes). In the multivariable analysis, the lateral body length of the distal humerus (p = 0.047, odds ratio = 0.734, 95% confidence interval: 0.542-0.996) and plate length (p = 0.036, odds ratio = 0.076, 95% confidence interval: 0.542-0.996) were associated with hardware-related complications.
Most patients developed hardware-related complications, particularly with short plates, mainly because of the narrow lateral body length of the distal humerus. Surgeons should be careful to secure EADHP in the appropriate position, especially when short plates are used in patients with narrow lateral body length.
我们旨在确定接受解剖锁定钢板固定治疗关节外肱骨远端骨折患者中与内固定相关的并发症的发生率和危险因素。
2013 年至 2020 年，回顾性分析了接受关节外肱骨远端锁定钢板（EADHP）切开复位内固定治疗的关节外肱骨远端骨折患者，并根据是否存在与内固定相关的并发症进行分类。与内固定相关的并发症定义为钢板处皮肤突出和日常生活活动不适。分析患者的人口统计学资料、外侧髁角、外侧体长度、肱骨干-髁间角和钢板长度。
29 例患者中，10 例（34%）未发生与内固定相关的并发症（A 组），19 例（66%）发生（B 组）。两组患者的人口统计学资料无差异。然而，B 组行内固定取出术的患者明显多于 A 组（16/19 比 4/10；p=0.032）。影像学评估显示外侧髁和骨干-髁间角无显著差异。然而，A 组的外侧体长度大于 B 组（44.5±4.8 比 39.5±3.7，p=0.007）。钢板长度在两组间差异显著。B 组 19 例（63%）患者中有 12 例接受短孔钢板（6 孔），而 A 组 10 例（90%）患者中有 9 例接受长孔钢板（8 孔）。多变量分析显示，肱骨远端外侧体长度（p=0.047，优势比=0.734，95%置信区间：0.542-0.996）和钢板长度（p=0.036，优势比=0.076，95%置信区间：0.542-0.996）与与内固定相关的并发症相关。
大多数患者发生了与内固定相关的并发症，尤其是使用短钢板的患者，主要原因是肱骨远端外侧体长度较窄。外科医生应注意将 EADHP 固定在适当的位置，特别是在使用窄外侧体长度的患者中使用短钢板时。
