Functional Outcome Analysis of Parallel-Plate technique for distal humerus fractures

Dinesh, L (2013) Functional Outcome Analysis of Parallel-Plate technique for distal humerus fractures. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Fractures of the distal humerus accounts for 2-6% of all fractures and 1/3 of all humeral fractures. Intraarticular distal humerus fractures are very rare accounting for 0.5% of all fractures. In this modern society with a growing elderly population and a extremely active young population, the incidence of distal humeral fractures is increasing and having a bimodal distribution .In young adults, most distal humerus fractures occur from high-energy trauma like sideswipe injuries, motor vehicle accidents(MVA). In elderly persons with more osteoporotic bone, these injuries occur from simple falls. As a result of ongoing search for a more secure technique, later evolved the concept of parallel plating (180°), which involves placing one plate along the medial column of the distal humerus and the other plate along the lateral column, with the screws in the distal fragment interdigitating with each other restoring the ‘tie-beam arch’ of the distal humerus. Several biomechanical studies have proven the superiority of parallel over traditional plating methods, yet there are only fewer clinical studies to analyse the functional outcome of parallel plating in distal humerus fracture fixation. AIM: To analyse the functional outcome of patients treated with parallel plate technique in distal humeral fractures in Institute of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai from May 2010 to November 2012. MATERIALS AND METHODS: A prospective study was done to evaluate the functional outcome of parallel plating technique in treatment of distal humeral fractures and to analyse the results. The study group consists of 24 Patients with distal humeral fractures, who underwent osteosynthesis with parallel plating technique between May 2010 and Oct 2012 at the institute of orthopaedics and traumatology, Madras medical college and Rajiv Gandhi Government General Hospital, Chennai. The study was done with clearance from Hospital ethical committee. Those who fulfilled the inclusion criteria given below were invited to participate in the study. Informed consent was obtained from all the patients willing to take part in the study. Inclusion Criteria: 1. Intra articular fractures of distal humerus, 2. Age >18 years, 3. AO Types A2,A3 and C (supracondylar and bicondylar), 4. Closed ,Grade I and grade II compound injuries, 5. Consenting to study. Exclusion Criteria: 1. With vascular injuries, 2. Grade III compound Open fractures, 3. severe unreconstructable intra-articular communited fractures in elderly, 4. uncooperative patients for the rehabilitation and follow up, 5. Patients who were not medically fit for surgery, 6. not willing to participate. RESULTS: One patient who had a nonunion at the osteotomy site was done a revision osteosynthesis with tension band wiring. No patient died during treatment or follow up. Twenty four patients of distal humeral fractures were treated surgically with parallel plating and analyzed with average follow up of 13months (6 months – 2 ½ years). In our study, solid radiologic union was achieved primarily in all patients. The average time to union was about 14 weeks. Hardware failure or Nonunion did not occur in any patient. The mean flexion-extension arc was 107°. The mean MEPS score was 82 in our study. The results were excellent for 8 elbows, good for 11, fair for 3, and poor for 2 patients. CONCLUSION: Incidence of complex distal humerus fractures among younger population is on the rise due to increasing motor vehicle accidents. Absolute stability of the system allows early post-operative rehabilitation and thence a better functional outcome. Good to excellent functional outcome was achieved in about 80% of the study group in terms of arc of motion and stability Absence of implant failure and non-union may be attributed to the highly stable construct system achieved by parallel plating. Though it appears to be a variant of traditional plate placement, It is completely a different concept providing a greater stability in steoporotic and communited bones. Parallel plating can be a successful technique for internal fixation of these complicated fractures when its principles are strictly adhered to.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Functional Outcome Analysis ; Parallel-Plate technique ; distal humerus fractures.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 14 Sep 2017 03:41
Last Modified: 14 Sep 2017 03:41

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