Fractures of the distal humerus, classification, diagnosis, treatment

Abstract

Introduction. Distal humerus fractures are associated with many problems like fracture comminution, osteoporotic bone and complex fracture anatomy. Majority of the distal humerus fractures (96%) have a complex pattern involving both the columns and the articular surface (AO type B and C injuries). Distal humerus fractures comprise 1–2% of all fractures in adults with a reported incidence of 5.7 per 100 000 per year. Aim of the study. To evaluate the intermediate term results (follow up of two years) of distal humerus fractures according to data from medical records, implementation of AO classification (Arbeitsgemeinschaft für Osteosynthesefragen) and its codification, type of implant used in fracture fixation, specific parameters of elbow postsurgical treatment. Materials and methods. We have proposed a study of patients with distal humerus fractures (DHF) which consecutively was treated in departament of Hand Pathology with the application of microsurgical techniques (6 Section) of Traumatology and Orthopedics Clinical Hospital, Chisinau in the period 2016-2017. Final outcomes were determined by using Disabilities of Arm and Shoulder and Hand (DASH) score and the Mayo Elbow Performance (MEP) score calculated along with complete range of motion. All results were presented as mean ± standard deviation (±SD). Results. According to AO codification of DHF were determinate type A – 10, type B – 6, type C – 40 and in total were investigate 56 patients. The report between sex was 3:1 (42:14) with predomination of female gender. In three cases was achieved close reduction of FHD type A and fixation was obtained with k-wires. In rest patients were apply open reduction and internal fixation according to AO types of FDH in type A – 2 case was use k-wire an tension bands – and one case orthogonal plating; type B – lag screw in 2 cases and k-wires fixation in 4 cases; in type C was the main goal to obtain the triangular stability with restauration of three columns and were used k-wire an tension bands in 20 cases, orthogonal plating in 9 cases and at 11 cases parallel plating. All fractures healed, and radiographic union was observed at an average of 3 months. Was possible to investigate MEP and DASH scores at 19 patients with a mean of 85±17 and 39±23. Conclusions. Outcome of open reduction and internal fixation of distal humerus fractures can result in high union rates with acceptable outcome DASH and MEP scores.