Surgical Treatment of Comminuted Coronal Shear Fracture of Distal Humerus. Issue 5 (26th September 2020)

• Record Type: Journal Article
• Authors: Teng, Lin; Zhong, Gang
• Other Names: SCARLAT MARIUS M. guestEditor.; WU XIAO‐MING guestEditor.
• Is Part Of: Orthopaedic surgery. Volume 12:Issue 5(2020)
• Page Start: 1439
• Page End: 1447
• Publication Date: 2020-09-26
• Subjects: Capitellum -- Distal humeral fracture -- Internal fixation -- Trochlea; Orthopedic surgery -- Periodicals; Orthopedics -- Periodicals; Musculoskeletal system -- Wounds and injuries -- Periodicals; 617.47005
• DOI: 10.1111/os.12765
• Languages: English
• ISSNs: 1757-7853

Abstract

Abstract : Objective: To investigate the surgical approach, fixation, and clinical effect of comminuted coronal shear fracture of distal humerus. Methods: From March 2017 to February 2019, we had used open reduction and internal fixation to treat 19 cases of comminuted distal humeral coronal shear fracture. There were 8 males and 11 females, with an average age of 44.6 years (19–72 years). There were 10 cases on left side and 9 cases on right side. All cases were closed fractures. According to Dubberley's classification, there were six cases of type 1, six cases of type 2, and seven cases of type 3. The lateral Kocher approach, extended Kocher approach, extended Kocher approach combined with a medial incision and the olecranon osteotomy approach were used for exposure. Headless screw, Kirschner wire, and suture were used to fix the fractures. Two cases were fixed with hinged elbow fixators additionally. The follow‐up was evaluated by Mayo Elbow Performance Score (MEPS). Results: All patients were followed up for an average of 17.1 months (range, 12 to 30 months). The average time of fracture union was 8.8 ± 1.9 weeks. There were three cases of degenerative osteoarthritis of elbow and one case of heterotopic ossification after operation. A total of 10 patients underwent removal of implants. At the last follow‐up, the elbow flexion‐extension arc was 130.5° ± 10.5°. The forearm rotation arc was 167.4° ± 6.1°. The MEPS was 85.8 ± 8.5, the results were classified as excellent in nine cases, good in eight, and fair in two. The excellent and good rate was 89.5%. The time of fracture union of type 1 was shorter than type 3 ( P = 0.024), the elbow flexion‐ extension arc of type 1 fracture was better than type 2 ( P = 0.043) and type 3 ( P = 0.012), the forearm rotation arc of type 1 fracture was better than type 3 ( P = 0.006), the MEPS of type 1 fracture was better than type 2 ( P = 0.009) and type 3 ( P = 0.002). Conclusion: Open reduction and internal fixation with headless screw, Kirschner wire, and suture can be used for the treatment of comminuted distal humeral coronal shear fractures. The elbow joint function can be restored satisfactorily. Abstract : Experience of 19 comminuted distal humeral coronal shear fractures who received open reduction and internal fixation were present in this article. ORIF with headless screw, Kirschner wire, and suture are helpful for anatomical reduction of fracture and restoration of joint integrity.