Osteosynthesis Of Distal Humerus Fracture In Adults Using Triceps Reflecting Approach
Journal Title: International Journal of Orthopaedics Traumatology & Surgical Sciences - Year 2016, Vol 2, Issue 2
Abstract
Introduction: Intraarticular fractures of the distal humerus comprise 1% of all fractures in adults and involve both the medial and lateral columns. The distribution of distal humerus fractures follows a bimodal age distribution. Recent studies have emphasised the importance of surgical approach, anatomical reconstructon, rigid fixation and early rehabilitation. Numerous operative approaches for the management of distal humeral fractures have been described. Described approaches include the paratricipital (AlonsoLlames), triceps-reflecting (Bryan-Morrey), triceps- reflecting anconeus pedicle (TRAP), triceps-splitting, and olecranon osteotomy techniques. All described approaches have its own merits and demerits.with this we are assessing outcome of these distal humerus fracture fixation with triceps reflecting approach. Materials: 25 patients with distal humerus fracture who came to our hospital Bangalore Medical College and Research Institute were treated with posterior triceps reflecting approach. fracture was fixed using orthogonal or parallel plating techniques with metaphyseal LCP/ Reconstruction plates. Physiotherapy started from 3rd day postop with passive ROM exercises. Patient was followed at 1mth, 2 mnth, 3mth, 6 mth, 1 year and 2 year. Clinical outcome was assessed using the DASH SCORE, radiological union and complications were noted. Results: Post operative functional assessment done after 6 month of surgery. functional assessment with respect to range of movement, fracture union done. B the mean DASH score was 14 points (range, 0 to 100 points). The mean arc of flexion was 115° (range, 85 to 122). Mean pronation was 76° (range, 60-85) and supination was 74° (range, 60-80).The mean lossof range of motion, as compared with that of the contralateral elbow was 8 degrees. 2 patients had extensor lag of 5 degrees. Discussion: The principles of surgical management of intra-articular fractures of the distal humerus are anatomical restoration of the articular surface and stable fixation of the fracture fragments to allow for early motion. Careful preoperative planning, surgical expertise, and aggressive postoperative rehabilitation are essential for optimizing outcome. Orthogonal plating may be preferred in cases of an anterior shear fracture where the fixation from posterior to anterior will provide additional stability to the intra-articular fractures. Parallel plating may be the preferred technique utilized for very distal fracture Conclusion: We conclude that internal fixation of intraarticular fractures of the distal humerus is an effective procedure with an excellent or good functional outcome in most patient age groups. Patients have a high level of satisfaction and the majority returns to their previous level of activity.
Authors and Affiliations
Dayanand M, Lokesh Holagundi, Deepak S
Keywords
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