O1454 COMPLEX FRACTURES OF THE DISTAL HUMERUS: RESULTS OF INTERNAL FIXATION USING A PRINCIPLE-BASED TECHNIQUE

Abstract

Aims: The purpose of this study was to determine the outcome of fracture fixation with a principle-based technique that maximizes screw purchase in the articular fragments and compression at the supracondylar level. Methods: Thirty-one consecutive complex distal humerus fractures were fixed with two (medial and lateral) parallel plates applied according to the following principles: (1) all distal screws pass through plates, and (2) are anchored into a fragment on the opposite side fixed by a plate, (3) distal screws are as long and numerous as possible, (4) supracondylar interfragmentary compression is applied, and (5) full motion with no protection is routinely commenced within 36 hours after surgery. Twenty-five fractures (81 per cent) were AO type C3 and fourteen (42 per cent) were open. Two patients died in the first month after surgery. The remaining patients were followed for a mean of two years. Results: Neither hardware failure nor fracture displacement occurred in any patient. Union was achieved primarily in 28 cases (97 per cent). Three patients underwent further surgery for heterotopic ossification with associated stiffness. Another patient required interposition arthroplasty for secondary degenerative changes. At most recent follow-up, twenty-four elbows had no or mild pain and the median flexion- extension arc was from 27 to 124 degrees. The mean Mayo Elbow Performance Score was 83.1 points (range, fifty-five to 100 points). The results were graded as excellent in nine, good in fifteen, fair in two and poor in three cases. Conclusions: Fixation of complex fractures of the distal humerus with the above-described principle-based technique allows intensive rehabilitation of elbow motion immediately after surgery and is associated with a high union rate.