AO Tip C Distal Humerus Kırıklarında Ortogonal ve Paralel LC-DCP Plaklamanın Klinik ve Radyolojik Sonuçlarının Karşılaştırılması

Yıl 2022, , 63 - 70, 18.03.2022

Mehmet Baydar , Fatih Arslanoğlu Çağrı Özcan , Kahraman Öztürk

https://doi.org/10.31832/smj.1014491

Öz

Amaç: AO tip C distal humerus kırıkları, dirsek anatomisinin zorluğu ve kırık kemik parçalarının küçük olması nedeniyle redükte edilmesi ve düzeltilmesi zor kırıklardır. Humerus distal kırığı için paralel plaklama tekniği biyomekanik olarak daha üstün olmasına rağmen, klinik koşullarda ortogonal plaklama tekniğinin Tip C humerus kırıkları için paralel plaklama yöntemi kadar güvenilir ve etkili olduğunu varsayıyoruz.
Gereç ve Yöntem: 2012-2018 yılları arasında AO tip C distal humerus kırığı nedeniyle ameliyat edilen ve çalışmaya alınma kriterlerini karşılayan 36 hasta retrospektif olarak değerlendirildi. 20 hastaya paralel, 16 hastaya ortogonal (medial ve posterolateral) plaklama uygulandı. Tüm hastalar LC-DCP plakları ile tespit edildi. Her iki grup için aşağıdaki veriler toplandı: yaş; Cinsiyet; taraf; operasyondan önceki süre; sigara alışkanlıkları; kırık tipi; ek yaralanma; kaynama zamanı; takip süresi; Quick DASH, Mayo dirsek ve VAS skorları; kavrama gücü; dirsek EHA; ekstansiyon kaybı; ve son kontrolde komplikasyonlar değerlendirildi.
Bulgular: Gruplar arasında yaş, cinsiyet, taraf, ameliyattan önceki süre, sigara içme alışkanlığı, kırık tipi ve ek yaralanma açısından istatistiksel olarak anlamlı fark yoktu (P> 0.05). Gruplar arasında Quick DASH, Mayo dirsek veya VAS skorları, kavrama gücü, dirsek EHA, ekstansiyon kaybı, kaynama süresi, postoperatif heterotrofik ossifikasyon, dirsek ve olekranon kaynamama, ameliyat sonrası nöropraksi veya diğer komplikasyonlar açısından istatistiksel olarak anlamlı fark yoktu (P > 0.05). Ulnar sinir transpozisyonu açısından iki grup arasında istatistiksel olarak anlamlı bir fark vardı (P<0.05).
Sonuç: Literatürde sıklıkla kullanılan paralel plaklama ile ortogonal plaklama arasında tip C distal humerus kırıklarının tedavisinde fonksiyonel, radyolojik veya komplikasyon açısından bir avantaj bulunmamaktadır. Cerrah, kırığın tipine ve her iki kolonun nasıl kırıldığına bağlı olarak her iki tekniği de güvenle kullanabilir.

Anahtar Kelimeler

humerus distal kırıkları, paralel plaklama, ortogonal plaklama, eklem içi kırıklar

Destekleyen Kurum

Yok

Comparison of Clinical and Radiological Results of Orthogonal and Parallel LC-DCP Plating in AO Type C Distal Humerus Fractures

Öz

Objective: AO (Arbeitsgemeinschaft für Osteosynthesefragen) type C distal humerus fractures are difficult fractures to reduce and fix due to the difficulty of the elbow anatomy and small size of the broken bone parts. We hypothesize that although parallel plating technique is biomechanically superior for humerus distal fracture, orthogonal plating technique in clinical conditions is as reliable and effective as a method of parallel plating for Type C humerus fractures.
Materials and Methods: Between 2012 and 2018, 36 patients who underwent operations for AO type C distal humerus fractures and met the inclusion criteria were evaluated retrospectively. Parallel plating was performed in 20 patients and orthogonal plating (medial and posterolateral plating) in 16 patients. All patients were fixed with LC-DCP plates. Quick DASH, Mayo elbow, and VAS scores; grip strength; elbow ROM (Range of Motion); extension loss; and evaluations complications at the last visit.
Results: There was no statistically significant difference between the groups in terms of the Quick DASH, Mayo elbow, or VAS scores, grip strength, elbow ROM, extension loss, union time, postoperative heterotrophic ossification, elbow and olecranon nonunion, post-op neuropraxia, or other complications (P > 0.05). There was a statistically significant difference between the two groups regarding ulnar nerve transposition (P <0.05).
Conclusion: There are no functional, radiological, or complicated advantages between parallel plating and orthogonal plating, which are frequently used in the literature, for treating type C distal humerus fractures. The surgeon can safely use both techniques, depending on the type of fracture and how both columns are broken.

Anahtar Kelimeler

Humerus distal fractures, Parallel plating, Orthogonal plating, intraarticular fractures

Kaynakça

• 1. Komurcu M. Uras I. Yavuz OY . Application of locking plates in distal humeral fractures. TOTBİD Journal 2012;11(1):28-33 https://doi.org/10.5606/totbid.dergisi.2012.04
• 2. Robinson CM, Hill RM, Jacobs N, Dall G, Court-Brown CM. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma 2003 17:38–47. . https://doi.org/10.1097/00005131-200301000-00006
• 3. Srinivasan K, Agarwal M, Matthews SJ, Giannoudis PV. Fractures of the distal humerus in the elderly: is internal fixation the treatment of choice? Clin Orthop Relat Res 2005;(434): 222-30 . https://doi.org/10.1097/01.blo.0000154010.43568.5b
• 4. Abzug JM, Dantuluri PK. Use of orthogonal or paralel plating techniques to treat distal humerus fractures. Hand Clin. 2010 ;26(3):411-21 https://doi.org/10.1016/j.hcl.2010.05.008
• 5. Gabel GT, Hanson G, Bennett JB, Noble PC, Tullos HS. Intraarticular fractures of the distal humerus in the adult. Clin Orthop Relat Res. 1987 Mar;(216):99-108
• 6. Huang TL, Chiu FY, Chuang TY, Chen TH. The results of open reduction and internal fixation in elderly patients with severe fractures of the distal humerus: a critical analysis of the results. J Trauma. 2005 ;58(1):62-9 https://doi.org/10.1097/01.ta.0000154058.20429.9c
• 7. O’Driscoll SW. Optimizing stability in distal humeral fracture fixation. J Shoulder Elbow Surg 2005;14(1 Suppl S):186–94. https://doi.org/10.1016/j.jse.2004.09.033
• 8. Yadav V, Sharma P, Gohiya A. Functional outcome of intraarticular distal humerus fracture fixation using triceps-sparing paratricipital approach. Indian J Orthop. 2016 ;50(6):595-601. https://doi.org/10.4103/0019-5413.193487
• 9. Reising K, Hauschild O, Strohm PC, Suedkamp NP. Stabilisation of articular fractures of the distal humerus: early experience with a novel perpendicular plate system Injury. 2009;40(6):611-7. https://doi.org/10.1016/j.injury.2008.12.018
• 10. Atalar AC, Demirhan M, Salduz A, Kiliçoğlu O, Seyahi A. Functional results of the parallel plate technique for complex distal humerus fractures Acta Orthop Traumatol Turc. 2009 Jan-Feb;43(1):21-7. https://doi.org/10.3944/AOTT.2009.021
• 11. Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, et al. Fracture and dislocation classification compendium— 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 2007;21:S1–S133 https://doi.org/10.1097/00005131-200711101-00001
• 12. Zarezadeh A, Mamelson K, Thomas WC, Schoch BS, Wright TW, King JJ. Outcomes of distal humerus fractures: What are we measuring? Orthop Traumatol Surg Res. 2018 ;104(8):1253-1258. https://doi.org/10.1097/00005131-200711101-00001
• 13. Athwal GS, Hoxie SC, Rispoli DM, Steinmann SP. Precontoured parallel plate fixation of AO/OTA type C distal humerus fractures. J Orthop Trauma. 2009;23(8): 575-87 https://doi.org/10.1097/BOT.0b013e3181aa5402
• 14. Eryuva V, Altay T, Kayalı C, Kement Z, Çıtak C. Comparison of 90° and 180° plate constructions for comminuted distal humerus fractures in adults, and effects on clinical results Ulus Travma Acil Cerrahi Derg. 2016 Jul;22(4):386-90 . https://doi.org/10.5505/tjtes.2016.18827
• 15. Helfet DL, Schmeling GJ. Bicondylar intraarticular fractures of the distal humerus in adults. Clin Orthop Relat Res 1993;292:26–36
• 16. Zalavras CG, Papasoulis E. Intra-articular fractures of the distal humerus-a review of the current practice. Int Orthop. 2018;42(11):2653-2662. .https://doi.org/10.1007/s00264-017-3719-4
• 17. Papaioannou N, Babis GC, Kalavritinos J, Pantazopoulos T. Operative treatment of type C intra-articular fractures of the distal humerus: the role of stability achieved at surgery on final outcome. Injury 1995;26(3):169–173. https://doi.org/10.1016/0020-1383(95)93495-4
• 18. Caravaggi P, Laratta JL, Yoon RS, Biasio J, Ingargiola M, Frank M, et al Internal fixation ofthe distal humerus: a comprehensive biomechanical study evaluating current fixation techniques. J Orthop Trauma. 2014;28(4):222-6. https://doi.org/10.1097/BOT.0b013e3182a6693f
• 19. Self J, Viegas SF, Buford WL Jr, Patterson RM. A comparison of double-plate fixation methods for complex distal humerus fractures. J Shoulder Elbow Surg. 1995;4(1 Pt 1):10-6. https://doi.org/10.1016/s1058-2746(10)80002-3
• 20. Jacobson SR, Glisson RR, Urbaniak JR. Comparison of distal humerus fracture fixation: a biomechanical study. J South Orthop Assoc. 1997;6(4):241-9.
• 21. Lee SK, Kim KJ, Park KH, Choy WS. A comparison between orthogonal and parallel plating methods for distal humerus fractures: a prospective randomized trial. Eur J Orthop Surg Traumatol. 2014;24(7):1123-31. https://doi.org/10.1007/s00590-013-1286-y
• 22. Yu X, Xie L, Wang J, Chen C, Zhang C, Zheng W. Orthogonal plating method versus parallel plating method in the treatment of distal humerus fracture: A systematic review and meta-analysis. Int J Surg. 2019;69:49-60. https://doi.org/10.1016/j.ijsu.2019.07.028
• 23. Schuster I, Korner J, Arzdorf M, Schwieger K, Diederichs G, Linke B. Mechanical comparison in cadaver specimens of three different 90-degree double plate osteo syntheses for simulated C2-type distal humerus fractures with varying bone densities. J Orthop Trauma. 2008;22(2):113-20.https://doi.org/10.1097/BOT.0b013e3181632cf8
• 24. Koziarz A, Woolnough T, Oitment C, Nath S, Johal H. Surgical Management for Olecranon Fractures in Adults: A Systematic Review and Meta-analysis. Orthopedics. 2019;1;42(2):75-82. https://doi.org/10.3928/01477447-20190221-03
• 25. Amir S, Jannis S, Daniel R. Distal humerus fractures: a review of current therapy concepts. Curr Rev Musculoskelet Med. 2016 ;9(2):199-206. https://doi.org/10.1007/s12178-016-9341-z
• 26. Elmadag M, Erdil M, Bilsel K. The olecranon osteotomy provides better outcome than the triceps-lifting approach for the treatment of distal humerus fractures. Eur J Orthop Surg Traumatol. 2014;24(1): 43–50. https://doi.org/10.1007/s00590-012-1149-y
• 27. Ring D, Gulotta L, Chin K, Jupiter JB. Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus. J Orthop Trauma. 2004;18(7):446–9. 22. https://doi.org/10.1097/00005131-200408000-00010
• 28. Fusaro I, Orsini S, Stignani Kantar S, Sforza T, Benedetti M G, Betteli G. et al. Elbow rehabilitation in traumatic pathology. Musculoskelet Surg. 2014;98 Suppl 1:95-102. https://doi.org/10.1007/s12306-014-0328-x
• 29. Athwal G, Hoxie S, Rispoli D, Steinmann S. Precontoured parallel plate fixation of AO/OTA type C distal humerus fractures. J Orthop Trauma 2009;23:575–80. . https://doi.org/10.1097/BOT.0b013e3181aa5402
• 30. Gofton W, MacDermid J, Patterson S, Faber KJ, King G. Functional outcome of AO type C distal humeral fractures. J Hand Surg 2003;28-A:294–308. https://doi.org/10.1053/jhsu.2003.50038
• 31. Worden A, Ilyas AM. Ulnar neuropathy following distal humerus fracture fixation. Orthop Clin North Am. 2012;43(4):509-14. https://doi.org/10.1016/j.ocl.2012.07.019