Surgical and economic management of distal humerus fractures

Abstract

Introduction. Distal humerus fractures have a complex pattern involving both the columns and the articular surface (AO type B and C injuries) and represent 30% of all elbow fractures, with a reported incidence of 5.7 per 100,000 per year in adults. Federer et al. (2019) estimate a total cost of 20.669 dollars on 12 patients with complete articular fracture of the distal humerus. 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 surgery, type of implant used in fracture fixation, economic management, specific parameters of elbow post-surgical treatment. Materials and methods. We have proposed a study of surgical and economic management patients with distal humerus fractures (DHF) which consecutively was treated in the Department of Hand Surgery with the application of microsurgical techniques of Traumatology and Orthopedics Clinical Hospital, Chisinau in the period 2018-2019. Results. According to AO codification of DHF were determinate type A – 11(A1-1; A2-9; A3-1) , type B – 10(B1 - 2; B2 - 2; B3 -6 ), type C – 35(C1-26; C2-4; C3-5 ) and in total were investigate 56 patients. The report between sex was 2,5:1 (40:16) with a predominance of the female gender. In three cases was achieved a 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 – 9 case was used k-wire a tension bands – and 2 case orthogonal plating; type B – lag screw in 6 cases, k-wires fixation in 3 cases, platting 1 case; in type C was the main goal to obtain the triangular stability with restoration of three columns and were used k-wire, screws and tension bands in 29 cases, orthogonal plating or parallel plating in 8 cases. In distal humerus fractures, surgery was used 11 plates, 101 screws, 258 kwires, 30,1 m of metallic wire and the total cost of these implants is 11385,8 MDL per total care cost of 28582,65 MDL. Conclusions. Economic management of open reduction and internal fixation of distal humerus fractures have potential volume and need improvement to fit the standard of absolute stability in osteosynthesis with plates of distal humerus fractures.