Dual Plating Osteosynthesis Technique used for Fixation of Inter - Condylar Distal Humerus Fractures via Transolecranon Approach

Abstract

INTRODUCTION: The dual plate osteosynthesis technique for fixation of inter-condylar distal humerus fracture is now considered an accepted treatment modality. It provides a rigid fixation of fracture fragments to enable early post-operative mobilization for good outcome. OBJECTIVE: The purpose of study is to assess the morbidity and clinico-radiological outcome of the dual plating osteosynthesis technique used for fixation of inter-condylar distal humerus fractures (DHF) via trans-olecranon approach METHODOLOGY: This perspective cross sectional study was carried at Department of Orthopaedic Surgery, Dow Medical College / Civil Hospital Karachi from June 2014 to March 2016. A total of 21adult patients with comminuted inter-condylar fracture of the distal humerus operated with dual plating osteosynthesis technique via trans-olecranon approach were evaluated clinically and radiologically for functional outcome based on Jupiter criteria including alignment and fracture union after a mean follow-up of 8 months. Post surgical complications were noted. Fractures were classified according to Muller et al (AO). Patients with polytrauma, pathological fracture, open fracture and a fracture more than 2 week old were excluded from the study. RESULTS: Out of the 21 patients, 38% were female and 62% were male. 52.3% had left elbow while 47.6% had right elbow involvement. The mean age was 31 years (range 20 - 50 years). Mean time between injury and internal fixation was 4.8 days. The mean follow-up period was 8 months. As per AO classification, 10 cases were C1, 7 cases C2 while 4 cases were in C3. The most common cause of fracture was road traffic accident in 13 cases. All fractures achieved anatomical restoration of articular surface and were united in average 14.6 weeks. The clinical results were evaluated for functional outcome based on Jupiter criteria. According to that criterion, satisfactory results were obtained in all patients. We had no instance of postoperative deep infection and neurological complications, only Backing of olecranon K-wires were noted in 5 patients (23.8%). CONCLUSIONS: We conclude that dual plate osteosynthesis technique is an effective procedure for fixation of inter-condylar distal humerus fracture, achieves rigid fixation and hence, early mobilization. Additionally use of olecranon osteotomy offers best fracture exposure of distal humerus. Complications were minimal and healing satisfactory.