Open Reduction And Internal Fixation With The AO Anatomic Plating Systems For Type C Fractures Of The Adult Distal Humerus

Distal humeral fracture is a high-energy trauma accounts for 2% of all fractures. The complex articular anatomy, limited nonarticular bone stock of the distal fragment, associated articular and supracondylar comminution, and proximity of neurovascular structures combine to challenge the treating surgeon. In recent years various surgical implants and techniques had been devised to improve surgical outcomes. ORIF using double plating of the medial and lateral column is the gold standard for treatment of distal humerus fracture in adults. The treatment of adult distal humeral fracture C by AO anatomic plating systems achieve a satisfactory effect.Objectives: We evaluated functional results of patients treated with open reduction and internal fixation with the plates are pre-contoured to fit the natural anatomy of the elbow for the type C fractures of the adult distal humerus.Methods: To review the patients with type C fractures of the dista1 humerus who were treated in our hospital between January, 2005～december,2009. 36 patients underwent open reduction and internal fixation exclusively with the AO anatomic plating systems.The mean age of the patients at the time of fracture was 52 years (range, 20–65 years) and there were 22men and 14 women. According to the AO classification, eleven fractures were graded as C1 (30.5%), sixteen as C2 (44.4%), and nine as C3 (25%). The mean time to surgery was three days (range 1 to 5 days). All fractures were close fracture. One patient had combined median nerve injuries, two patients combined lower extremity fractures, one patient had combined clavicle fracture. there was no patients combined head trauma. All fractures were exposed through a posterior skin incision. We used AO anatomic plating systems, the plates are pre-contoured to fit the natural anatomy of the elbow , involves the placement of medial and lateral column plates at 90 angles. All patients were fixed with plaster cast after operation, passive motion was begun in the next day. Removed plaster after operation three weeks, active functional exercise was initiated All patients of this group were followed-up with periodical clinical and radiographic evaluations. Elbow flexion and extension were measured with a goniometer. Fracture healing was defined by fracture healing clinical standard. Functional results were evaluated using the DASH (Disabilities of the Arm, Shoulder and Hand) score.Results: All patients of this group were followed-up, The mean follow-up was 11.5 months (range 9to 16 months). All the patients obtained bone union. The mean duration of fracture healing was 13 weeks. The mean total range of motion was 100.42±18.76°, flexion was 119.03±12.58°, and extension was -19.03±11.51°. The mean DASH score were 9.14±6.16. Three patients among the 36 patients(8.3%) underwent delayed ulnar nerve symptoms after the operation. Two patients(2.7%) improved after treatment with giving nutrition neural, One patient(2.7%) performed anterior transposition of ulnar nerve due to not improved after treatment with giving nutrition neural. Heterotopic ossification of varying degrees was seen in three patients (8.3%).Conclusion: Treated with open reduction and internal fixation with the plates are pre-contoured to fit the natural anatomy of the elbow for the type C fractures of the adult distal humerus is safe. Functional results are satisfactory in distal humerus fractures treated with stable internal fixation and allow early passive functional exercise.