Posterior-Posterior Dual Plates Fixation for the Distal Humerus Fractures

Yoon-Min Lee; Seok-Whan Song; Ki-Bum Choi; Yoo-Joon Sur; Sung-Eun Kim

doi:10.12671/jkfs.2013.26.4.254

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Lee, Song, Choi, Sur, and Kim: Posterior-Posterior Dual Plates Fixation for the Distal Humerus Fractures

Original Article

Journal of the Korean Fracture Society 2013; 26(4): 254-260.

Published online: 18 October 2013

DOI: https://doi.org/10.12671/jkfs.2013.26.4.254

Posterior-Posterior Dual Plates Fixation for the Distal Humerus Fractures

Yoon-Min Lee, M.D., Seok-Whan Song, M.D., Ph.D., Ki-Bum Choi, M.D., Yoo-Joon Sur, M.D., Ph.D.^*, Sung-Eun Kim, M.D.

Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, Korea.

^*Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea School of Medicine, Korea.

Address reprint requests to: Seok-Whan Song, M.D., Ph.D. Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea School of Medicine, 222 Banpodaero, Seocho-gu, Seoul 137-701, Korea. Tel: 82-2-3779-1192, Fax: 82-2-783-0252, sw.song@catholic.ac.kr

Received 9 December 2012 Revised 21 February 2013 Accepted 14 July 2013

(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/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Fractures of the distal humerus are one of the challenging injuries due to its complex anatomy and accompanied comminution. For dual plate fixation, orthogonal or parallel plating is widely used, but the better of the two is debatable. The purpose of this study was to report another fixation technique that yielded good clinical results with early bone union of distal humerus fracture, namely, posterior-posterior plate fixation.

Materials and Methods

From March 2003 to March 2012, 20 patients with distal humerus fractures were treated by posterior-posterior plate fixation. The triceps reflecting approach was used with anterior transposition of the ulnar nerve. The mean age at the time of injury was 45 years (range, 26 to 78 years). By AO classification of distal humerus fractures, there were one case of A2 and B3 respectively, two cases of each A3, C1 and C3, and twelve cases of C2.

Results

The mean period of complete bone union was 7.1 weeks (range, 4 to 11 weeks). The mean flexion-extension range of motion of the elbow joint at last follow-up was 116.2 degrees. The mean pronation was 81.2 degrees and supination was 83.1 degrees. Plates and screws were removed at about nine months after the initial surgery. No cases showed complications or required additional operation.

Conclusion

Posterior-posterior dual plates fixation resulted in stable bicortical screw fixation, and insertion of lag screws were possible without interference. Posterior-posterior plating could be an easy and stable fixation method that provides good clinical results.

Keywords: Distal humerus, Fracture, Posterior-posterior plate fixation

Figures and Tables

Fig. 1

(A) Initial radiographs show a distal humerus fracture with comminution (AO classification C2).

(B) Fracture site was well reduced and fixed with posterior-posterior dual plates.

(C) Last follow-up radiographs

Fig. 2

(A) Initial radiographs show fixation failure with anterior angulation and nonunion of the fracture site.

(B) At postoperation 12 weeks, union was achieved at the nonunion site.

Table 1

Summary of Cases

MEPS: Mayo elbow performance score, F/U: Follow up, M: Male, F: Female, TA: Traffic accident.

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