Surgical Treatment Using a Transolecranon Approach with a Dual Locking Plate for Unstable Intercondylar Fractures of the Humerus

Ji-Kang Park; Yong-Min Kim; Dong-Soo Kim; Eui-Sung Choi; Hyun-Chul Shon; Kyoung-Jin Park; Byung-Ki Cho

doi:10.12671/jkfs.2012.25.2.129

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Park, Kim, Kim, Choi, Shon, Park, and Cho: Surgical Treatment Using a Transolecranon Approach with a Dual Locking Plate for Unstable Intercondylar Fractures of the Humerus

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2012; 25(2): 129-135.

Published online: 17 April 2012

DOI: https://doi.org/10.12671/jkfs.2012.25.2.129

Surgical Treatment Using a Transolecranon Approach with a Dual Locking Plate for Unstable Intercondylar Fractures of the Humerus

Ji-Kang Park, M.D., Yong-Min Kim, M.D., Dong-Soo Kim, M.D., Eui-Sung Choi, M.D., Hyun-Chul Shon, M.D., Kyoung-Jin Park, M.D., Byung-Ki Cho, M.D.

Department of Orthopedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.

Address reprint requests to: Byung-Ki Cho, M.D. Department of Orthopedic Surgery, Chungbuk National University Hospital, 410, Seongbong-ro, Heungdeok-gu, Cheongju 361-711, Korea. Tel: 82-43-269-6077, Fax: 82-43-274-8719, titanick25@yahoo.co.kr

Received 15 August 2011 Revised 25 September 2011 Accepted 16 December 2011

Abstract

Purpose

To evaluate the clinical outcomes of operative treatment using a transolecranon approach with a dual locking plate for unstable intercondylar fractures of the distal humerus.

Materials and Methods

Eighteen patients were followed for more than 1 year after surgical treatment for unstable intercondylar fractures of the humerus. Anterior transpositioning of the ulnar nerve and an early rehabilitation program to allow range of motion (ROM) exercise from postoperative week 1 were used for all cases. The clinical and functional evaluation was performed according to the Mayo Elbow Performance Index and Cassebaum's classification of ROM.

Results

The range of elbow joint motion was a flexion contracture mean of 12.8 degrees to a further flexion mean of 119.3 degrees at the final follow-up. The Mayo Elbow Performance Index was an average of 88.5 points. Among the results, 6 were excellent, 9 good, 2 fair, and 1 poor. Therefore, 15 cases (83.3%) achieved satisfactory results. Fourteen cases (77.7%) achieved a satisfactory ROM according to Cassebaum's classification. All cases achieved bone union, and the interval to union was an average of 14.2 weeks.

Conclusion

Dual locking plate fixation through the transolecranon approach seems to be one of the effective treatment methods for unstable intercondylar fractures of the humerus because it enables the anatomical reduction and rigid fixation of articulation, and early rehabilitation exercise.

Keywords: Humerus, Intercondylar fracture, Transolecranon approach, Dual locking plate

Figures and Tables

Fig. 1

(A) Operative photographs show olecranon osteotomy and extensive metaphyseal comminution. The ulnar nerve (tagged with a vessel loop) is protected and transposed anteriorly.

(B) Temporary K-wire fixation following the restoration of articulation.

(C) Internal fixation with dual locking-compression plates.

Fig. 2

(A~C) A 20 year-old man sustained a distal humeral intercondylar fracture classified as AO type C2.

(D~E) Three-month follow-up radiographs show complete bony union with dual locking-compression plates.

(F~G) Photographs show excellent functional results.

Fig. 3

(A~B) Three-month follow-up radiographs show complete bony union with heterotopic ossification (arrow).

(C~D) Postoperative radiographs after implant removal and bony spur excision.

Table 1

Evaluation of clinical results with the Mayo Elbow Performance Index at final follow-up

SD: Standard deviation.

Table 2

Evaluation of elbow range of motion with Cassebaum's classification system

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