EFFECTIVENESS OF LIMITED INTERNAL FIXATION COMBINED WITH HINGED SUPER-ARTICULAR EXTERNAL FIXATOR FOR TYPE C3 FRACTURE OF DISTAL HUMERUS IN ADULT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XULong , ZHAOSichun , WUShizhou , GUOJinhai ,  HUANGFuguo

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding author：

HUANGFuguo, Email: huang-f-g@163.com

Keywords：

Distal humeral fracture; Limited internal fixation; External fixator

DOI：

10.7507/1002-1892.20150147

Video：

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Objective To investigate the effectiveness of limited internal fixation combined with hinged super-articular external fixator to treat type C3 fracture of the distal humerus. Methods Between September 2007 and November 2012, 37 cases of type C3 fracture of the distal humerus were treated. There were 22 males and 15 females with an average age of 43.6 years (range, 22-66 years). The causes were accident injury in 24 cases, falling injury in 5 cases, falling from height in 4 cases, heavy crush injury in 2 cases, machine injury in 1 case, and other injury in 1 case. There were 22 cases of open injury and 15 cases of closed injury. The time from injury to operation was 3-46 hours (mean, 18 hours). Results Needle tract reaction and incision infection occurred in 3 cases and 1 case respectively, healing of incision by first intension was obtained in the other cases. Thirty-six patients were followed up 9-48 months (mean, 25.4 months). Heterotopic ossification occurred in 3 cases after operation and no recurrence was found by release after fracture healing. Fractures healed in the other patients after 6-14 months (mean, 9 months) of operation except 1 patient who suffered chronic osteomyelitis. One patient had delayed ulnar neuritis at 12 months after operation, and the nerve function returned to normal after the ulnar nerve transposition. There was no bone ischemic necrosis, elbow joint instability, or loosening of internal fixation. At last follow-up, the average range of motion of injured elbow was 105.0° in flexion,-25.0° in extension, 69.2° in pronation, and 75.6° in supination. According to Mayo elbow joint function score (MEPS) and disability of arm shoulder and hand (DASH) score, the results were excellent in 22 cases, good in 8 cases, fair in 4 cases, and poor in 2 cases with an excellent and good rate of 83.3%; and according to Cassebaum elbow joint function score, the results were excellent in 21 cases, good in 7 cases, fair in 5 cases, and poor in 3 cases with an excellent and good rate of 77.8%. Conclusion A combination of limited internal fixation and hinged super-articular external fixator has satisfactory clinical curative effect for type C3 fractures of the distal humerus, relatively few complications.

Citation： XULong, ZHAOSichun, WUShizhou, GUOJinhai, HUANGFuguo. EFFECTIVENESS OF LIMITED INTERNAL FIXATION COMBINED WITH HINGED SUPER-ARTICULAR EXTERNAL FIXATOR FOR TYPE C3 FRACTURE OF DISTAL HUMERUS IN ADULT. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(6): 678-682. doi: 10.7507/1002-1892.20150147 Copy

1.	张贵林, 李楠, 伊明江, 等. 经肱三头肌两侧入路治疗肱骨髁间骨折. 中华骨科杂志, 2001, 21(5):279-282.
2.	Jupiter JB, Neff U, Holzach P, et al. Intracondylar fractures of the humerus:an operative approach. J Bone Joint Surg (Am), 1985, 67(2):226-239.
3.	Anglen J. Distal humerus fractures. J Am Acad Orthop Surg, 2005, 13(5):291-297.
4.	Pollock JW, Faber KJ, Athwal GS. Distal humerus fractures. Orthop Clin North Am, 2008, 39(2):187-200.
5.	Kickuth R, Laufer U, Hartong G, et al. 3D CT versus axial helical CT versus conventional tomography in the classification of acetabular fractures:a ROC analysis. Clin Radiol, 2002, 57(2):140-145.
6.	O'Driscoll SW. The triceps-reflecting an coneus pedicle (TRAP) approach for distal humeral fractures and nonunions. Orthop Clin North Am, 2000, 31(1):91-101.
7.	Ljunqquist KL, Beran MC, Awan H. Effects of surgical approach on functional outcomes of open reduction and internal fixation of intra-articular distal humeral fractures:a systematic review. J Shoulder Elbow Surg, 2012, 21(1):126-135.
8.	袁天祥, 马宝通, 刘林涛, 等. 肱骨髁间粉碎性骨折的手术疗效分析. 中国矫形外科杂志, 2006, 14(4):257-259.
9.	Schildhauer TA, Nork SE, Mills WJ, et al. Extensor mechanism-sparing paratricipital posterior approach to the distal humerus. J Orthop Trauma, 2003, 17(5):374-378.
10.	徐杏荣, 冯万文, 李向东, 等. 经保留伸肘装置的后侧入路手术治疗成人肱骨远端骨折. 中国修复重建外科杂志, 2014, 28(7):921-922.
11.	周晓清, 唐金山, 张刚, 等. 两种方法治疗肱骨远端C型骨折疗效比较分析. 海南医学, 2011, 22(12):60-63.
12.	Iordens GI, Den Hartog D, Van Lieshout EM, et al. Good functional recovery of complex elbow dislocations treated with hinged external fixation:a multicenter prospective study. Clin Orthop Relat Res, 2015, 473(4):1451-1461.
13.	Maniscalco P, Pizzoli AL, Renzi Brivio L, et al. Hinged external fixation for complex fracture-dislocation of the elbow in elderly people. Injury, 2014, 45 Suppl 6:S53-57.
14.	郭志民, 翟文亮, 林斌, 等. 肘关节外固定架结合内固定治疗肱骨髁间骨折的生物力学评价. 中国临床解剖学杂志, 2005, 23(4):427-430.
15.	Wong AS, Baratz ME. Elbow fractures:distal humerus. J Hand Surg (Am), 2009, 34(1):176-190.
16.	Haasper C, Jagodzinski M, Krettek C, et al. Hinged external fixation and closed reduction for distal humerus fracture. Arch Orthop Trauma Surg, 2006, 126(3):188-191.
17.	Deuel CR, Wolinsky P, Shepherd E, et al. The use of hinged external fixation to provide additional stabilization for fractures of the distal humerus. J Orthop Trauma, 2007, 21(5):323-329.
18.	Lee DH. Treatment options for complex elbow fracture dislocations. Injury, 2001, 32 Suppl 4:SD41-69.
19.	Allende CA, Allende BT, Allende BL, et al. Intercondylar distal humerus fractures-surgical treatment and results. Chir Main, 2004, 23(2):85-95.
20.	Stavlas P, Gliatis J, Polyzois V, et al. Unilateral hinged external fixator of the elbow in complex elbow injuries. Injury, 2004, 35(11):1158-1166.

1. 张贵林, 李楠, 伊明江, 等. 经肱三头肌两侧入路治疗肱骨髁间骨折. 中华骨科杂志, 2001, 21(5):279-282.
2. Jupiter JB, Neff U, Holzach P, et al. Intracondylar fractures of the humerus:an operative approach. J Bone Joint Surg (Am), 1985, 67(2):226-239.
3. Anglen J. Distal humerus fractures. J Am Acad Orthop Surg, 2005, 13(5):291-297.
4. Pollock JW, Faber KJ, Athwal GS. Distal humerus fractures. Orthop Clin North Am, 2008, 39(2):187-200.
5. Kickuth R, Laufer U, Hartong G, et al. 3D CT versus axial helical CT versus conventional tomography in the classification of acetabular fractures:a ROC analysis. Clin Radiol, 2002, 57(2):140-145.
6. O'Driscoll SW. The triceps-reflecting an coneus pedicle (TRAP) approach for distal humeral fractures and nonunions. Orthop Clin North Am, 2000, 31(1):91-101.
7. Ljunqquist KL, Beran MC, Awan H. Effects of surgical approach on functional outcomes of open reduction and internal fixation of intra-articular distal humeral fractures:a systematic review. J Shoulder Elbow Surg, 2012, 21(1):126-135.
8. 袁天祥, 马宝通, 刘林涛, 等. 肱骨髁间粉碎性骨折的手术疗效分析. 中国矫形外科杂志, 2006, 14(4):257-259.
9. Schildhauer TA, Nork SE, Mills WJ, et al. Extensor mechanism-sparing paratricipital posterior approach to the distal humerus. J Orthop Trauma, 2003, 17(5):374-378.
10. 徐杏荣, 冯万文, 李向东, 等. 经保留伸肘装置的后侧入路手术治疗成人肱骨远端骨折. 中国修复重建外科杂志, 2014, 28(7):921-922.
11. 周晓清, 唐金山, 张刚, 等. 两种方法治疗肱骨远端C型骨折疗效比较分析. 海南医学, 2011, 22(12):60-63.
12. Iordens GI, Den Hartog D, Van Lieshout EM, et al. Good functional recovery of complex elbow dislocations treated with hinged external fixation:a multicenter prospective study. Clin Orthop Relat Res, 2015, 473(4):1451-1461.
13. Maniscalco P, Pizzoli AL, Renzi Brivio L, et al. Hinged external fixation for complex fracture-dislocation of the elbow in elderly people. Injury, 2014, 45 Suppl 6:S53-57.
14. 郭志民, 翟文亮, 林斌, 等. 肘关节外固定架结合内固定治疗肱骨髁间骨折的生物力学评价. 中国临床解剖学杂志, 2005, 23(4):427-430.
15. Wong AS, Baratz ME. Elbow fractures:distal humerus. J Hand Surg (Am), 2009, 34(1):176-190.
16. Haasper C, Jagodzinski M, Krettek C, et al. Hinged external fixation and closed reduction for distal humerus fracture. Arch Orthop Trauma Surg, 2006, 126(3):188-191.
17. Deuel CR, Wolinsky P, Shepherd E, et al. The use of hinged external fixation to provide additional stabilization for fractures of the distal humerus. J Orthop Trauma, 2007, 21(5):323-329.
18. Lee DH. Treatment options for complex elbow fracture dislocations. Injury, 2001, 32 Suppl 4:SD41-69.
19. Allende CA, Allende BT, Allende BL, et al. Intercondylar distal humerus fractures-surgical treatment and results. Chir Main, 2004, 23(2):85-95.
20. Stavlas P, Gliatis J, Polyzois V, et al. Unilateral hinged external fixator of the elbow in complex elbow injuries. Injury, 2004, 35(11):1158-1166.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF LIMITED INTERNAL FIXATION COMBINED WITH HINGED SUPER-ARTICULAR EXTERNAL FIXATOR FOR TYPE C3 FRACTURE OF DISTAL HUMERUS IN ADULT

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