Treatment of distal humerus fracture with unexposed ulnar nerve medial elbow incision and anatomical locking compression plate_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Tenglong ¹ , XU Tao ¹ , LIANG Hong ¹ , LAN Lin ¹ , LUO Qiang ¹ , LI Dapeng ¹ , YAN Chun ¹ , LIU Anxiong ¹ ,  YUAN Yi ²

1. Department of Orthopaedics, Pingshan Traditional Chinese Medicine Hospital, Pingshan Sichuan, 645350, P.R.China;
2. Department of Orthopaedics, Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;

Corresponding author：

YUAN Yi, Email: 270483309@qq.com

Keywords：

Ulnar nerve; distal humerus fracture; locking compression plate; internal fixation

DOI：

10.7507/1002-1892.201808077

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Objective To investigate the feasibility and effectiveness of unexposed ulnar nerve medial elbow incision, open reduction and internal fixation of anatomical locking compression plate (LCP) for distal humerus fractures.Methods Fourteen patients with distal humerus fracture were treated between January 2014 and June 2017. There were 5 males and 9 females, aged 18-85 years (mean, 65.5 years). The causes of injury included falling from height in 12 cases and traffic accident in 2 cases, all were closed fractures. Fractures were classified according to the AO/Association for the Study of Internal Fixation (AO/ASIF): 3 cases of type A2, 2 cases of type A3, 4 cases of type B2, 2 cases of type C1, 2 cases of type C2, and 1 case of type C3; without ulnar nerve damage. The time from injury to operation was 4-15 days, with an average of 7 days. The type B2 fractures were treated with unexposed ulnar nerve elbow medial incision and anatomic LCP internal fixation, the rest patients were all treated with unexposed ulnar nerve medial plus conventional lateral approach and bilateral LCP internal fixation.Results The operation time was 50-140 minutes (mean, 80 minutes), and the intraoperative blood loss was 20-200 mL (mean, 70 mL). There was no blood vessels or nerve damage during operation. All incisions healed by first intension, and no incision infection occurred. All the 14 cases were followed up 9-24 months (mean, 13 months). X-ray films showed that all fractures healed within 4 months without complications such as nonunion and osteomyelitis. No ulnar nerve injury, cubitus varus deformity, and ossifying myositis occurred during follow-up. At last follow-up, the elbow function was assessed by Mayo Elbow Performance score (MEPS), the results were excellent in 8 cases, good in 4 cases, fair in 1 case, and poor in 1 case (type C3 fracture), with the excellent and good rate of 85.7%.Conclusion The unexposed ulnar nerve medial elbow incision can be used effectively to reduct the fracture, and it is not prone to ulnar nerve injury. Combined with the lateral approach to treat the distal humerus fracture, which has the advantages of short operation time, few trauma, little bleeding, and reliable effectiveness.

Citation： ZHANG Tenglong, XU Tao, LIANG Hong, LAN Lin, LUO Qiang, LI Dapeng, YAN Chun, LIU Anxiong, YUAN Yi. Treatment of distal humerus fracture with unexposed ulnar nerve medial elbow incision and anatomical locking compression plate. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(4): 440-444. doi: 10.7507/1002-1892.201808077 Copy

1.	Beazley JC, Baraza N, Jordan R, et al. Distal humeral fractures-current concepts. Open Orthop J, 2017, 11: 1353-1363.
2.	Zlotolow DA, Catalano LW 3rd, Barron OA, et al. Surgical exposures of the humerus. J Am Acad Orthop Surg, 2006, 14(13): 754-765.
3.	魏力标, 安智全. 肱骨远端骨折手术治疗研究进展. 国际骨科学杂志, 2017, 38(6): 353-356.
4.	Yamaguchi K, Sweet FA, Bindra R, et al. The extraneural and intraneural arterial anatomy of the ulnar nerve at the elbow. J Shoulder Elbow Surg, 1999, 8(1): 17-21.
5.	Ruan HJ, Liu JJ, Fan CY, et al. Incidence, management, and prognosis of early ulnar nerve dysfunction in type C fractures of distal humerus. J Trauma, 2009, 67(6): 1397-1401.
6.	Shearin JW, Chapman TR, Miller A, et al. Ulnar nerve management with distal humerus fracture fixation: a meta-analysis. Hand Clin, 2018, 34(1): 97-103.
7.	McKee MD, Jupiter JB, Bosse G, et al. Outcome of ulnar neurolysis during post-traumatic reconstruction of the elbow. J Bone Joint Surg (Br), 1998, 80(1): 100-105.
8.	余英剑, 穆天旺, 陈伟全, 等. 尺神经肌下前置在C型肱骨远端骨折治疗中的应用. 实用医学杂志, 2010, 26(11): 1982-1983.
9.	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.
10.	张川, 张作君, 昌中孝, 等. 肱三头肌两侧入路和鹰嘴V形截骨入路治疗肱骨远端 C3型骨折疗效比较. 中国修复重建外科杂志, 2018, 32(10): 1321-1325.
11.	Nauth A, McKee MD, Ristevski B, et al. Distal humeral fractures in adults. J Bone Joint Surg (Am), 2011, 93(7): 686-700.
12.	Vazquez O, Rutgers M, Ring DC, et al. Fate of the ulnar nerve after operative fixation of distal humerus fractures. J Orthop Trauma, 2010, 24(7): 395-399.
13.	Chen RC, Harris DJ, Leduc S, et al. Is ulnar nerve transposition beneficial during open reduction internal fixation of distal humerus fractures? J Orthop Trauma, 2010, 24(7): 391-394.
14.	王思群, 吴建国, 夏新雷, 等. 重建钢板固定和尺神经前置治疗肱骨髁间骨折. 中华骨科杂志, 2003, 23(8): 474-478.
15.	吴佳卉. 臂丛神经或全身麻醉双钛板内固定治疗肱骨远端C型骨折. 中国实用神经疾病杂志, 2012, 15(3): 67-68.
16.	孟德强, 刘德昌, 张新潮, 等. 肱骨髁间骨折双锁定钢板内固定尺神经前置的临床效果分析. 创伤外科杂志, 2015, 17(1): 36-38.

1. Beazley JC, Baraza N, Jordan R, et al. Distal humeral fractures-current concepts. Open Orthop J, 2017, 11: 1353-1363.
2. Zlotolow DA, Catalano LW 3rd, Barron OA, et al. Surgical exposures of the humerus. J Am Acad Orthop Surg, 2006, 14(13): 754-765.
3. 魏力标, 安智全. 肱骨远端骨折手术治疗研究进展. 国际骨科学杂志, 2017, 38(6): 353-356.
4. Yamaguchi K, Sweet FA, Bindra R, et al. The extraneural and intraneural arterial anatomy of the ulnar nerve at the elbow. J Shoulder Elbow Surg, 1999, 8(1): 17-21.
5. Ruan HJ, Liu JJ, Fan CY, et al. Incidence, management, and prognosis of early ulnar nerve dysfunction in type C fractures of distal humerus. J Trauma, 2009, 67(6): 1397-1401.
6. Shearin JW, Chapman TR, Miller A, et al. Ulnar nerve management with distal humerus fracture fixation: a meta-analysis. Hand Clin, 2018, 34(1): 97-103.
7. McKee MD, Jupiter JB, Bosse G, et al. Outcome of ulnar neurolysis during post-traumatic reconstruction of the elbow. J Bone Joint Surg (Br), 1998, 80(1): 100-105.
8. 余英剑, 穆天旺, 陈伟全, 等. 尺神经肌下前置在C型肱骨远端骨折治疗中的应用. 实用医学杂志, 2010, 26(11): 1982-1983.
9. 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.
10. 张川, 张作君, 昌中孝, 等. 肱三头肌两侧入路和鹰嘴V形截骨入路治疗肱骨远端 C3型骨折疗效比较. 中国修复重建外科杂志, 2018, 32(10): 1321-1325.
11. Nauth A, McKee MD, Ristevski B, et al. Distal humeral fractures in adults. J Bone Joint Surg (Am), 2011, 93(7): 686-700.
12. Vazquez O, Rutgers M, Ring DC, et al. Fate of the ulnar nerve after operative fixation of distal humerus fractures. J Orthop Trauma, 2010, 24(7): 395-399.
13. Chen RC, Harris DJ, Leduc S, et al. Is ulnar nerve transposition beneficial during open reduction internal fixation of distal humerus fractures? J Orthop Trauma, 2010, 24(7): 391-394.
14. 王思群, 吴建国, 夏新雷, 等. 重建钢板固定和尺神经前置治疗肱骨髁间骨折. 中华骨科杂志, 2003, 23(8): 474-478.
15. 吴佳卉. 臂丛神经或全身麻醉双钛板内固定治疗肱骨远端C型骨折. 中国实用神经疾病杂志, 2012, 15(3): 67-68.
16. 孟德强, 刘德昌, 张新潮, 等. 肱骨髁间骨折双锁定钢板内固定尺神经前置的临床效果分析. 创伤外科杂志, 2015, 17(1): 36-38.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of distal humerus fracture with unexposed ulnar nerve medial elbow incision and anatomical locking compression plate

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