Department of Orthopedic Surgery, Yeungnam University Medical Center, Yeungnam University Hospital, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, Korea.
BMC Musculoskelet Disord. 2022 Aug 11;23(1):764. doi: 10.1186/s12891-022-05594-1.
Low transcondylar fractures (LTFs) of the distal humerus are relatively uncommon elbow injuries in elderly patients after low-energy injuries. Although there is still debate regarding the method of fixation, several surgeons prefer bi-columnar fixation using pre-contoured locking plates. However, posterior approaches, which are usually used to perform the above procedure, have disadvantages, such as ulnar nerve neuropathy, damage to the extensor mechanism, and the need for general anesthesia. To solve these problems, the authors designed a combined medial and lateral approach. The purpose of this study was to present the outcomes of bi-columnar internal fixation through a combined medial and lateral approach for the treatment of LTFs of the distal humerus in the elderly. METHODS: A total of 46 patients diagnosed with distal humeral fractures between May 2017 and April 2020 were included. Thirty patients were excluded, and 16 patients who underwent open reduction and internal fixation by the medial and lateral approach were selected. We carried out all the surgeries under brachial plexus anesthesia. The clinical outcomes were assessed based on the visual analog scale (VAS) score, Mayo elbow performance score (MEPS), disabilities of the arm, shoulder, and hand (DASH) score, and range of motion (ROM) of the elbow joint. Standardized radiographs were obtained at 3, 6, and 12 months after surgery and at the last follow-up visit to evaluate for bony union and to check for complications, such as ulnar nerve neuropathy and heterotopic ossification.
The mean age was 81 years (range, 65-91 years). Bony union was achieved in 15 out of 16 patients. The mean VAS score was 2.1 (range, 0-6), the mean MEPS was 84.4 (range, 70-100), and the mean DASH score was 20.6 (range, 9.5-33.6). There were three complications including reduction loss, skin necrosis, and stiffness of the elbow. There was no ulnar nerve neuropathy. The post-operative ROM was 100 degrees or higher in all cases, which did not cause any impairment in daily life.
LTFs of the distal humerus in the elderly can yield satisfactory results with bi-columnar internal fixation through a combined medial and lateral approach.
低能量损伤后，老年人的髁间下骨折（LTFs）是相对少见的肘部损伤。尽管对于固定方法仍存在争议，但一些外科医生更喜欢使用预成型锁定板进行双柱固定。然而，通常用于进行上述手术的后入路存在一些缺点，如尺神经神经病、伸肌机制损伤和需要全身麻醉。为了解决这些问题，作者设计了一种联合内侧和外侧入路。本研究的目的是介绍通过联合内侧和外侧入路进行双柱内固定治疗老年人髁间下骨折的结果。
共纳入 2017 年 5 月至 2020 年 4 月期间诊断为肱骨远端骨折的 46 例患者。排除 30 例患者，选择 16 例接受内侧和外侧入路切开复位内固定的患者。所有手术均在臂丛神经麻醉下进行。根据视觉模拟评分（VAS）评分、梅奥肘功能评分（MEPS）、上肢残疾指数（DASH）评分和肘关节活动范围（ROM）评估临床结果。术后 3、6 和 12 个月以及末次随访时拍摄标准 X 线片评估骨愈合情况，并检查并发症，如尺神经神经病和异位骨化。
平均年龄为 81 岁（65-91 岁）。16 例患者中有 15 例达到骨性愈合。VAS 评分平均为 2.1（0-6），MEPS 平均为 84.4（70-100），DASH 评分平均为 20.6（9.5-33.6）。有 3 例并发症，包括复位丢失、皮肤坏死和肘部僵硬。无尺神经神经病。所有病例术后 ROM 均为 100°或更高，日常生活不受影响。
通过联合内侧和外侧入路进行双柱内固定治疗老年人髁间下骨折可获得满意的结果。
