Clinical Results of Open Reduction and Internal Fixation in the Coronal Plane Articular Fracture of the Distal Humerus

Young-Su Byun; Dong-Ju Shin; Jin-Myoung Dan; Seong-Man Lee; Dae-Geun Jeong; Tae-Hoe Gu; Sung-Soo Ha

doi:10.4055/jkoa.2016.51.4.301

Journal List > J Korean Orthop Assoc > v.51(4) > 1013458

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Byun, Shin, Dan, Lee, Jeong, Gu, and Ha: Clinical Results of Open Reduction and Internal Fixation in the Coronal Plane Articular Fracture of the Distal Humerus

Original Article

Journal of the Korean Orthopaedic Association 2016; 51(4): 301-307.

Published online: 11 August 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.4.301

Clinical Results of Open Reduction and Internal Fixation in the Coronal Plane Articular Fracture of the Distal Humerus

Young-Su Byun, M.D., Dong-Ju Shin, M.D., Jin-Myoung Dan, M.D.^*, Seong-Man Lee, M.D.^†, Dae-Geun Jeong, M.D., Tae-Hoe Gu, M.D., Sung-Soo Ha, M.D.

Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea.

^*Department of Orthopaedic Surgery, CHA Gumi Medical Center, CHA University, Gumi, Korea.

^†Goodssen Hospital, Daegu, Korea.

Correspondence to: Dong-Ju Shin, M.D. Department of Orthopaedic Surgery, Daegu Fatima Hospital, 99 Ayang-ro, Dong-gu, Daegu 41199, Korea. TEL: +82-53-940-7320, FAX: +82-53-940-7417, aabga@hanmail.net

Received 7 December 2015 Revised 22 December 2015 Accepted 6 December 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to evaluate the surgical outcomes according to the Ring's classification system in patients with the distal humeral coronal plane articular fracture after treatment with open reduction and internal fixation (OR/IF).

Materials and Methods

Patients with the distal humeral coronal plane articular fracture treated with OR/IF in the three hospitals were reviewed retrospectively. The patients were evaluated clinically and radiographically according to the Ring's classification system.

Results

Eleven patients, including three males and eight female patients, with a mean age of 55 years (15–88 years) were enrolled in this study. Average Mayo elbow performance score was 85 (60–100), four patients had excellent, four had good, and three had fair results. Fracture union was achieved in ten of 11 patients who underwent open reduction and internal fixation. In the analysis of the results according to Ring's classification, patients presenting fracture of the posterior aspect of the lateral column showed worse clinical results than those who did not. It was the same for the patient presenting fracture of the posterior aspect of the trochlea.

Conclusion

The open reduction and internal fixation provides good clinical and radiologic outcomes for the distal humeral coronal plane articular fracture. Our results suggest that the type of fracture involvement with posterior aspect of trochlear or capitellum can result in poor clinical outcomes.

Keywords: elbow, humerus, coronal fracture, Ring's classification

Figures and Tables

Figure 1

Distal humerus articular surface, demonstrating the location of the five components of the articular fracture.

Figure 2

A 16-year-old male fell on the ground and injured the left elbow. (A, B) Antero-posterior X-ray and lateral X-ray and computed tomography of a type 2 distal humerus capitellar coronal shear fracture. (C) Intraoperative photo of the fracture. (D) Twenty-month postoperative anteroposterior and lateral X-ray of the patient fixed with a plate and screws. The patient had an excellent result.

Figure 3

A 69-year-old female fell on the ground and injuried the left elbow. (A, B) X-ray and computed tomography of a type 5 distal humerus capitellar coronal shear fracture. (C, D) Postoperative anteroposterior X-ray of patient treated with the total elbow arthroplasty. The patient had good result.

Figure 4

A 56-year-old female fell on the ground and injured the left elbow. (A, B) Anteroposterior X-ray and computed tomography of a type 4 distal humerus capitellar coronal shear fracture. (C) Postoperative anteroposterior X-ray of the patient fixed with multiple K-wires. K-wires were removed after one-year. (D) Anteroposterior X-ray taken after ten-months after removal of K-wires shows the non-union of fracture.

Table 1

Demographics of Patients

ROM, range of motion; MEPS, Mayo elbow performance score; F, female; M, male; TA, traffic accident; FG, fall on the ground; FH, fall from a height; E, excellent; G, good; F, fair.

Table 2

Result of the MEPS, ROM Compared to the Type of Ring's Classification

Values are presented as mean±standard deviation. MEPS, Mayo elbow performance score; ROM, range of motion.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

References

1. McKee MD, Jupiter JB, Bamberger HB. Coronal shear fractures of the distal end of the humerus. J Bone Joint Surg Am. 1996; 78:49–54.

2. Sabo MT, Fay K, McDonald CP, Ferreira LM, Johnson JA, King GJ. Effect of coronal shear fractures of the distal humerus on elbow kinematics and stability. J Shoulder Elbow Surg. 2010; 19:670–680.

3. Ring D, Jupiter JB, Gulotta L. Articular fractures of the distal part of the humerus. J Bone Joint Surg Am. 2003; 85-A:232–238.

4. Brouwer KM, Jupiter JB, Ring D. Nonunion of operatively treated capitellum and trochlear fractures. J Hand Surg Am. 2011; 36:804–807.

5. Dubberley JH, Faber KJ, Macdermid JC, Patterson SD, King GJ. Outcome after open reduction and internal fixation of capitellar and trochlear fractures. J Bone Joint Surg Am. 2006; 88:46–54.

6. Goodman HJ, Choueka J. Complex coronal shear fractures of the distal humerus. Bull Hosp Jt Dis. 2005; 62:85–89.

7. Mosheiff R, Liebergall M, Elyashuv O, Mattan Y, Segal D. Surgical treatment of fractures of the capitellum in adults: a modified technique. J Orthop Trauma. 1991; 5:297–300.

8. Sano S, Rokkaku T, Saito S, Tokunaga S, Abe Y, Moriya H. Herbert screw fixation of capitellar fractures. J Shoulder Elbow Surg. 2005; 14:307–311.

9. Stamatis E, Paxinos O. The treatment and functional outcome of type IV coronal shear fractures of the distal humerus: a retrospective review of five cases. J Orthop Trauma. 2003; 17:279–284.

10. Mighell M, Virani NA, Shannon R, Echols EL Jr, Badman BL, Keating CJ. Large coronal shear fractures of the capitellum and trochlea treated with headless compression screws. J Shoulder Elbow Surg. 2010; 19:38–45.

11. O'Driscoll SW, Jupiter JB, Cohen MS, Ring D, McKee MD. Difficult elbow fractures: pearls and pitfalls. Instr Course Lect. 2003; 52:113–134.

12. Lapner M, King GJ. Elbow arthroplasty for distal humeral fractures. Instr Course Lect. 2014; 63:15–26.

13. Ali A, Shahane S, Stanley D. Total elbow arthroplasty for distal humeral fractures: indications, surgical approach, technical tips, and outcome. J Shoulder Elbow Surg. 2010; 19:2 Suppl. 53–58.

14. Kamineni S, Morrey BF. Distal humeral fractures treated with noncustom total elbow replacement. J Bone Joint Surg Am. 2004; 86-A:940–947.

15. Sen RK, Tripahty SK, Goyal T, Aggarwal S. Coronal shear fracture of the humeral trochlea. J Orthop Surg (Hong Kong). 2013; 21:82–86.

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