Evaluation of risk factors for stiffness after distal humerus plating
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In distal humerus fractures, the goal is to achieve a functional range of motion of 30°–130° which is not always possible. The aims of the study were to evaluate the functional results after distal humerus fracture operation and to investigate the risk factors for stiffness.
Between 2005 and 2014, 75 patients with the mean age of 37.8 years (17–80) underwent open reduction and plate fixation for distal humerus fractures. Range of motion (ROM), Mayo elbow performance scores, and quick DASH scores were used for functional evaluation. Patients were divided into two groups according their ROM. Group 1 had > 100° of extension-flexion ROM and group 2 had < 100°. Older age (> 60), AO type C2–3 fracture, open fracture, longer injury-surgery interval, type of plating, and presence of olecranon osteotomy were investigated as risk factors for poor outcome.
At a mean follow-up of 25 months (6–80), 40 patients were in group 1 and 35 patients were in group 2. Group 1 had significantly better functional scores than group 2. AO type C2 and C3 fracture (odds ratio (OR) 16.6, p < 0.0001) and injury-surgery interval longer than 7 days (OR 2.59, p 0.047) were found as significant risk factors for stiffness.
Patients who had distal humerus fracture should be informed about the risk of elbow stiffness especially in AO type C2–C3 fractures and surgical treatment should be planned without any delay.
KeywordsDistal humerus fracture Risk factors Double plate fixation Stiffness
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Board of İstanbul University İstanbul Medical Faculty Orthopaedics and Traumatology Department.
For this type of study, formal consent is not required.
- 1.Rose SH, Melton LJ, 3rd, Morrey BF, Ilstrup DM, Riggs BL (1982) Epidemiologic features of humeral fractures. Clin Orthop Relat Res (168):24–30Google Scholar
- 5.Zhang C, Zhong B, Luo CF (2014) Comparing approaches to expose type C fractures of the distal humerus for ORIF in elderly patients: six years clinical experience with both the triceps-sparing approach and olecranon osteotomy. Arch Orthop Trauma Surg 134(6):803–811. https://doi.org/10.1007/s00402-014-1983-y CrossRefPubMedGoogle Scholar
- 9.Elmadag M, Erdil M, Bilsel K, Acar MA, Tuncer N, Tuncay I (2014) The olecranon osteotomy provides better outcome than the triceps-lifting approach for the treatment of distal humerus fractures. Eur J Orthop Surg Traumatol 24(1):43–50. https://doi.org/10.1007/s00590-012-1149-y CrossRefPubMedGoogle Scholar
- 12.Pidhorz L, Alligand-Perrin P, De Keating E, Fabre T, Mansat P, Societe francaise de chirurgie orthopedique et al (2013) Distal humerus fracture in the elderly: does conservative treatment still have a role? Orthop Traumatol Surg Res 99(8):903–907. https://doi.org/10.1016/j.otsr.2013.10.001 CrossRefPubMedGoogle Scholar
- 20.Mansat P, Nouaille Degorce H, Bonnevialle N, Demezon H, Fabre T, Sofcot (2013) Total elbow arthroplasty for acute distal humeral fractures in patients over 65 years old—results of a multicenter study in 87 patients. Orthop Traumatol Surg Res 99(7):779–784. https://doi.org/10.1016/j.otsr.2013.08.003 CrossRefPubMedGoogle Scholar
- 21.Obert L, Ferrier M, Jacquot A, Mansat P, Sirveaux F, Clavert P, Charissoux JL, Pidhorz L, Fabre T, Societe Francaise de Chirurgie Orthopedique et al (2013) Distal humerus fractures in patients over 65: complications. Orthop Traumatol Surg Res 99(8):909–913. https://doi.org/10.1016/j.otsr.2013.10.002 CrossRefPubMedGoogle Scholar
- 25.Atalar AC, Tunali O, Ersen A, Kapicioglu M, Saglam Y, Demirhan MS (2017) Biomechanical comparison of orthogonal versus parallel double plating systems in intraarticular distal humerus fractures. Acta Orthop Traumatol Turc 51(1):23–28. https://doi.org/10.1016/j.aott.2016.11.001 CrossRefPubMedGoogle Scholar
- 26.Kollias CM, Darcy SP, Reed JG, Rosvold JM, Shrive NG, Hildebrand KA (2010) Distal humerus internal fixation: a biomechanical comparison of 90 degrees and parallel constructs. Am J Orthop (Belle Mead NJ) 39(9):440–444Google Scholar
- 27.Koonce RC, Baldini TH, Morgan SJ (2012) Are conventional reconstruction plates equivalent to precontoured locking plates for distal humerus fracture fixation? A biomechanics cadaver study. Clin Biomech (Bristol, Avon) 27(7):697–701. https://doi.org/10.1016/j.clinbiomech.2012.03.008 CrossRefGoogle Scholar