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Published in: Journal of Orthopaedics and Traumatology 2/2015

Open Access 01-06-2015 | Original Article

Single locking compression plate fixation of extra-articular distal humeral fractures

Authors: Malhar N. Kumar, M. R. Ravishankar, Ravikiran Manur

Published in: Journal of Orthopaedics and Traumatology | Issue 2/2015

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Abstract

Background

Earlier literature on fixation of distal third humeral fractures describes the use of elaborate modification of existing implants, custom-made implants and dual plating. These modifications have the disadvantages of limitations of hardware availability and cost as well as longer surgical exposure to accommodate the plates. The aim of this study was to assess the effectiveness of osteosynthesis of extra-articular diaphyseal fractures of the distal third of the humerus using a single 4.5-mm locking compression plate (LCP) with two-screw purchase in the distal fragment.

Materials and methods

We performed internal fixation of distal third extra-articular humeral fractures in 22 adult patients using 2–3 lag screws neutralized with a single 4.5-mm locking compression plate with only two screws in the distal fragment. The mean follow-up period was approximately 1.6 years.

Results

Fractures united in all 22 patients with minimal complications. The mean time to union of fracture was 13 weeks. The Mayo elbow score and the DASH scores were in the excellent and good category in all patients at final follow-up.

Conclusions

Our study showed that it is possible to obtain excellent outcomes in distal third fractures using only a single 4.5-mm LCP with two-screw (4-cortices) purchase in the distal fragment. The disadvantages inherent in the previous methods can be avoided with the use of the present technique. This technique obviates the need for the use of customized distal humeral implants and modified implants in most patients.

Level of evidence

Level IV.
Literature
1.
go back to reference Stewart MJ, Hundley JM, Tennessee M (1955) Fractures of the humerus-A comparative study in methods of treatment. J Bone Joint Surg Am 37-A(4):11 Stewart MJ, Hundley JM, Tennessee M (1955) Fractures of the humerus-A comparative study in methods of treatment. J Bone Joint Surg Am 37-A(4):11
2.
go back to reference Sarmiento A, Horowitch A et al (1990) Functional bracing for comminuted extra-articular fractures of the distal third of the humerus. J Bone Joint Surg Br 72(2):283–287 Sarmiento A, Horowitch A et al (1990) Functional bracing for comminuted extra-articular fractures of the distal third of the humerus. J Bone Joint Surg Br 72(2):283–287
3.
go back to reference Ring D, Harris M, Doornberg J, McCarty P, Jawa A (2006) Extra-articular distal-third diaphyseal fractures of the humerus. A comparison of functional bracing and plate fixation. J Bone Joint Surg Am 88-A:2343–2347 Ring D, Harris M, Doornberg J, McCarty P, Jawa A (2006) Extra-articular distal-third diaphyseal fractures of the humerus. A comparison of functional bracing and plate fixation. J Bone Joint Surg Am 88-A:2343–2347
4.
go back to reference McKee MD (2006) Fractures of the shaft of the humerus. In: Bucholz RW, Heckman JD, Court-Brown CM (eds) Rockwood and green’s fractures in adults. Lippincott Williams & Wilkins, Philadelphia, pp 1117–1159 McKee MD (2006) Fractures of the shaft of the humerus. In: Bucholz RW, Heckman JD, Court-Brown CM (eds) Rockwood and green’s fractures in adults. Lippincott Williams & Wilkins, Philadelphia, pp 1117–1159
5.
go back to reference Archdeacon MT, Cannada LK, Herscovici D, Anglen JO (2008) Avoiding complications in the treatment of humeral fractures. J Bone Joint Surg Am 90-A:1580–1589 Archdeacon MT, Cannada LK, Herscovici D, Anglen JO (2008) Avoiding complications in the treatment of humeral fractures. J Bone Joint Surg Am 90-A:1580–1589
6.
go back to reference Livani B, Belangero WD, Castro de Medeiros R (2006) Fractures of the distal third of the humerus with palsy of the radial nerve: management using minimally-invasive percutaneous plate osteosynthesis. J Bone Joint Surg Br 88(12):1625–1628CrossRef Livani B, Belangero WD, Castro de Medeiros R (2006) Fractures of the distal third of the humerus with palsy of the radial nerve: management using minimally-invasive percutaneous plate osteosynthesis. J Bone Joint Surg Br 88(12):1625–1628CrossRef
7.
go back to reference Morrey BF, An KN, Chao EYS (1993) Functional evaluation of the elbow. In: Morrey BF (ed) The elbow and its disorders, 2nd edn. W. B. Saunders, Philadelphia, pp 86–89 Morrey BF, An KN, Chao EYS (1993) Functional evaluation of the elbow. In: Morrey BF (ed) The elbow and its disorders, 2nd edn. W. B. Saunders, Philadelphia, pp 86–89
8.
go back to reference Atroshi I, Gummesson I, Andersson B, Dahlgren E, Johansson A (2000) The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire. Acta Orthop Scand 71:613–618CrossRef Atroshi I, Gummesson I, Andersson B, Dahlgren E, Johansson A (2000) The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire. Acta Orthop Scand 71:613–618CrossRef
9.
go back to reference Levy JC, Kalandiak SP, Hutson JJ, Zych G (2005) An alternative method of osteosynthesis for distal humeral shaft fractures. J Orthop Trauma 19:43–47CrossRef Levy JC, Kalandiak SP, Hutson JJ, Zych G (2005) An alternative method of osteosynthesis for distal humeral shaft fractures. J Orthop Trauma 19:43–47CrossRef
10.
go back to reference Spitzer AB, Davidovitch RI, Egol KA (2009) Use of a ‘‘hybrid’’ locking plate for complex metaphyseal fractures and non unions about the humerus. Injury 40:240–244CrossRef Spitzer AB, Davidovitch RI, Egol KA (2009) Use of a ‘‘hybrid’’ locking plate for complex metaphyseal fractures and non unions about the humerus. Injury 40:240–244CrossRef
11.
go back to reference Zhiquan A, Bingfang Z, Yeming W, Chi Z, Peiyan H (2007) Minimally invasive plating osteosynthesis (MIPO) of middle and distal third humeral shaft fractures. J Orthop Trauma 21:628–633CrossRef Zhiquan A, Bingfang Z, Yeming W, Chi Z, Peiyan H (2007) Minimally invasive plating osteosynthesis (MIPO) of middle and distal third humeral shaft fractures. J Orthop Trauma 21:628–633CrossRef
12.
go back to reference Schatzker J, Tile M (1996) The rationale of operative fracture care, 2nd edn. Springer, Toronto, pp 83–94CrossRef Schatzker J, Tile M (1996) The rationale of operative fracture care, 2nd edn. Springer, Toronto, pp 83–94CrossRef
13.
go back to reference Prasarn ML, Ahn J, Paul O, Morris EM, Kalandiak SP, Helfet DL, Lorich DG (2011) Dual plating for fractures of the distal third of the humeral shaft. J Orthop Trauma 25:57–63CrossRef Prasarn ML, Ahn J, Paul O, Morris EM, Kalandiak SP, Helfet DL, Lorich DG (2011) Dual plating for fractures of the distal third of the humeral shaft. J Orthop Trauma 25:57–63CrossRef
14.
go back to reference Südkamp NP, Niemeyer P (2006) Principles and clinical application of the locking compression plate (LCP). Acta Chir Orthop Traumatol Cech 73:221–228 Südkamp NP, Niemeyer P (2006) Principles and clinical application of the locking compression plate (LCP). Acta Chir Orthop Traumatol Cech 73:221–228
15.
go back to reference Smith WR, Ziran BH, Anglen JO, Stahel PF (2007) Locking plates: tips and tricks. J Bone Joint Surg Am 89A:2298–2307 Smith WR, Ziran BH, Anglen JO, Stahel PF (2007) Locking plates: tips and tricks. J Bone Joint Surg Am 89A:2298–2307
16.
go back to reference Hak DJ, Althausen P, Hazelwood SJ (2010) Locked plate fixation of osteoporotic humeral shaft fractures: are two locking screws per segment enough? J Orthop Trauma 24:207–211CrossRef Hak DJ, Althausen P, Hazelwood SJ (2010) Locked plate fixation of osteoporotic humeral shaft fractures: are two locking screws per segment enough? J Orthop Trauma 24:207–211CrossRef
Metadata
Title
Single locking compression plate fixation of extra-articular distal humeral fractures
Authors
Malhar N. Kumar
M. R. Ravishankar
Ravikiran Manur
Publication date
01-06-2015
Publisher
Springer International Publishing
Published in
Journal of Orthopaedics and Traumatology / Issue 2/2015
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI
https://doi.org/10.1007/s10195-014-0325-8

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