Outcomes of the distal intraarticular humeral fractures treated by olecranon osteotomy

Year 2009, Volume: 36 Issue: 4, 241 - 247, 01.12.2009

Erhan Yılmaz Mehmet Bulut

Abstract

Objectives: To evaluate the management and outcome of intraarticular fractures of the distal humerus treated by open reduction and internal fixation using the olecranon osteotomy technique. Materials and methods: Twenty-one patients with intraarticular fractures of the distal humerus were treated by open reduction and internal fixation. The mean age of the patients was 41.6 years and the mean follow-up period was 25.3 months. All fractures were type C according to the AO/ASIF fracture classification system. Chevron type olecranon osteotomy was performed within 12- 24 h after the injury in all cases but 4 of them. Physical and radiological examination of patients with the appropriate range checks were made. Results: All fractures united within average duration of 3.2 months. Excellent or good results were found in patients less than 50 years-old, in women, when passing time from injury to surgery was within 12 hours and when early mobilization was achieved. The complications were seen as 2 (9.6%) transient neuropraxia of the ulnar nerve, 2 (9.6%) failure of fixation, 1 (4.8%) heterotopic ossification and 1 (4.8%) olecranon non-union. Fracture type (C1) and time from occurrence of injury to surgery (

Keywords

Distal humerus, intraarticular fracture, surgical treatment, olecranon osteotomy, early mobilization.

onuçları

Abstract

Amaç: Distal humerusun eklem içi kırıklarında olekranon osteotomisi yöntemiyle açık redüksiyon ve internal tesbit yapılan hastalarda tedavi sonuçlarının degerlendirilmesi. Gereç ve yöntem: Distal humerusta eklem içi kırıgı olan 21 hastaya olekranon osteotomisi yapılarak açık redüksiyon ve internal tesbit uygulandı. Hastaların ortalama yası 41.6 yıl ortalama takip süresi 25.3 ay idi. Kırıkların tamamı AO/ASIF kırık sınıflandırma sistemine göre tip-C idi. Chevron tipi olekranon osteotomisi yapılan hastaların dördü hariç digerleri yaralanmadan sonraki ilk 12-24 saat içerisinde ameliyata alındı. Uygun aralıklarla hastaların fizik muayene ve radyolojik kontrolleri yapıldı. Bulgular: Kırıkların tamamı ortalama 3.2 ayda kaynadı. Bayanlarda, 50 yasın altında, yaralanmayla ameliyata alınma arasındaki süre 12 saatin altında olan ve erken hareket baslanan hastalarda mükemmel ve iyi sonuçlar elde edildi. Komplikasyon olarak 2 (9.6%) hastada geçici unlar sinir nöropatisi, 2 (9.6%) hastada tesbit yetersizligi, 1 (4.8%) hastada heterotopik ossifikasyon, 1 (4.8%) hastada da olekranonda kaynamama görüldü. Kırıgın tipi (C1) ve yaralanmayla ameliyata alınma arasında geçen zaman (12 saat) mükemmel ve iyi fonksiyonel sonuçlar elde etmede ana belirleyici faktörlerdi. Sonuçlar: Dikkatli ve titiz cerrahi teknik, stabil internal tesbit, cerrahi tecrübe ve ameliyat sonrası erken kontrollü hareket distal humerusun eklem içi kırıklarının basarılı sonuçları için kritik faktörlerdir.

Keywords

Distal humerus, eklem içi kırık, cerahi tedavi, olekranon osteotomisi, erken hareket

References

• Gupta R. Intercondylar fractures of the distal humerus in adults. Injury 1996; 27: 569-572.
• Henley MB. Intra-articular distal humeral fractures in adults. Orthop Clin North Am 1987;18:11-23.
• Kinik H, Atalar H, Mergen E. Management of distal hume- rus fractures in adults. Arch Orthop Trauma Surg 1999; 119: 467-469.
• Ring D, Jupiter JB. Fractures of the distal humerus. Orthop Clin North Am 2000;31:103-113.
• Sodergard J, Sandelin J, Bostman O. Postoperative compli- cations of distal humeral fractures. Acta Orthop Scand 1992; 63: 85-89.
• Ziran BH, Smith WR, Balk ML, Manning CM, Agudelo JF. A true triceps-splitting approach for treatment of distal humerus fractures: a preliminary report. J Trauma 2005; 58:70-75.
• Kundel K, Braun W, Wieberneit J, Ruter A. Intra-articular distal humerus fractures. Factors affecting functional out- come. Clin Orthop 1996;332:200-208.
• Zhao J, Wang X, Zhang Q. Surgical treatment of commin- uted intra-articular fractures of the distal humerus with double 2000;23:449-452. Orthopedics
• Jupiter JB, Neff U, Holzach P, Allgower M. Intercondylar fractures of the humerus. An operative approach. J Bone Joint Surg 1985;67:226-239.
• Letsch R, Chmit-Neuerburg KP, Sturmer KM, Walz M. Intra-articular fractures of the distal humerus. Surgical treatment and results. Clin Orthop 1989;241:238-244.
• McKee MD, Wilson TL, Winston L, Schemitsch EH, Ri- chards RR. Functional outcome following surgical treat- ment of intra-articular distal humeral fractures through a posterior approach. J Bone Joint Surg 2000;82:1701-1707.
• Pollock JW, Faber KJ, Athwal GS. Distal humerus frac- tures. Orthop Clin North Am 2008;39:187-200.
• Zagorski JB, Jennings JJ, Burkhalter WE, Uribe JW. Comminuted intra-articular fractures of the distal humeral condyles. Surgical vs. nonsurgical treatment. Clin Orthop 1986;202:197-204.
• Ebraheim NA, Andreshak TG, Yeasting RA, Saunders RC, Jackson WT. Posterior extensile approach to the elbow joint and distal humerus. Orthop Rev 1993;22:578-582.
• Ring D, Gulotta L, Chin K, Jupiter JB. Olecranon osteot- omy for exposure of fractures and nonunions of the distal humerus. J Orthop Trauma 2004;18:446-449.
• Eralp L, Kocaoglu M, Sar C, Atalar AC. Surgical treat- ment of distal intra-articular humeral fractures in adults. Int Orthop 2001;25:46-50.
• Helfet DL, Schmeling GJ. Bicondylar intra-articular frac- tures of the distal humerus in adults. Clin Orthop 1993;292:26-36.
• Pajarinen J, Bjorkenheim JM. Operative treatment of type C intercondylar fractures of the distal humerus: Results af- ter a mean follow-up of 2 years in a series of 18 patients. J Shoulder Elbow Surg 2002;11:48-52.
• Wilkinson JM, Stanley D. Posterior surgical approaches to the elbow: a comparative anatomic study. J Shoulder El- bow Surg 2001;10:380-382.
• Aitken GK, Rorabeck CH. Distal humeral fractures in the adult. Clin Orthop 1986;207:191-197.
• Anglen J. Distal humerus fractures. J Am Acad Orthop Surg 2005;13:291-297.
• O’Driscoll SW. The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonun- ions. Orthop Clin North Am 2000;31:91-101.
• Archdeacon MT. Combined olecranon osteotomy and pos- terior triceps splitting approach for complex fractures of the distal humerus. J Orthop Trauma 2003;17:368-373.
• Holdsworth BJ, Mossad MM. Fractures of the adult distal humerus elbow function after internal fixation. J Bone Joint Surg 1990; 72-B: 362-365.
• Caja VL, Moroni A, Vendemia V, Sabato C, Zinghi G. Surgical treatment of bicondylar fractures of the distal humerus. Injury 1994; 25: 433-438
• Gabel GT, Hanson G, Bennett JB, Noble PC, Tullos HS. Intra-articular fractures of the distal humerus in the adult. Clin Orthop 1987; 216: 99-108.
• Sodergard J, Sandelin J, Bostman O. Mechanical failures of internal fixation in T and Y fractures of the distal hume- rus. J Trauma 1992; 33: 687-690.