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

Abstract

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.

Keywords

• Humerus distal fractures
• Parallel plating
• Orthogonal plating
• intraarticular fractures

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

Abstract

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.

Keywords

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

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