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Adjunctive intraosseous wiring fixation technique for the comminuted distal humeral fractures.

ABSTRACT: Distal humeral fractures are among the most challenging injuries to treat. Although precise repair of the articular surface is essential during surgery, accurate reconstruction of the metaphysis contributes to the overall stability of the fracture construct. The intraosseous wiring technique has been used for small-fragment fractures. However, its efficacy as an adjunct for distal humerus fixation has yet to be thoroughly investigated. This study aimed to demonstrate the applicability of this technique to comminuted, distal humeral fractures. In this retrospective case series, we describe 6 cases of intra-articular distal humerus fractures treated with this technique, followed by dual plating. We observed successful bone union in all patients, with the Mayo Elbow Performance Scores indicating "good" to "excellent" clinical outcomes for this procedure at the final follow-up. We believe that this intraosseous wiring technique should be an integral part of the toolbox of every surgeon because it is a relatively simple and highly effective procedure that requires no special instrument and can be used on various types of fractures.

SUBMITTER: Tsutsui S

PROVIDER: S-EPMC10624999 | biostudies-literature | 2023 Nov

REPOSITORIES: biostudies-literature

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Adjunctive intraosseous wiring fixation technique for the comminuted distal humeral fractures.

Tsutsui Sadaaki S Okano Ichiro I Kuroda Takuma T Kawasaki Keikichi K Inagaki Katsunori K

JSES reviews, reports, and techniques 20230624 4

Distal humeral fractures are among the most challenging injuries to treat. Although precise repair of the articular surface is essential during surgery, accurate reconstruction of the metaphysis contributes to the overall stability of the fracture construct. The intraosseous wiring technique has been used for small-fragment fractures. However, its efficacy as an adjunct for distal humerus fixation has yet to be thoroughly investigated. This study aimed to demonstrate the applicability of this te ...[more]

PMID: 37928982

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Project description:PurposeThe treatment of distal femur fractures with extensive metaphyseal comminution is frequently complicated by high rates of nonunion and varus collapse. Dual plating with lateral and medial locking plates for these types of fractures has shown promising results in the recent literature. We hypothesize that dual plating of comminuted distal femur fractures leads to higher union rates and lower revision rates compared to an isolated lateral locking plate.MethodsA retrospective medical chart review between January 2015 and December 2017 was conducted. Inclusion criteria included patients 18 years of age and older who sustained a complex distal femur fracture (AO/OTA 33-C2/33-C3 or periprosthetic fracture with significant metaphyseal comminution) and at least 6 months of follow up. Patients with simple fracture patterns, alternative fixation methods, and inadequate follow up were excluded. All patients in the single plating group were treated with a lateral distal femoral locking plate using a lateral approach. In the patients treated with dual plating, an extensile parapatellar approach was utilized for fracture reduction and placement of an adjunctive medial plate. Demographic information, fracture types, injury severity score (ISS), medical comorbidities, type of surgical fixation, union rates, complications, knee range of motion, time to follow up, and need for revision surgery were extrapolated from the medical charts for analysis.ResultsTwenty-one patients were included in the study. Thirteen patients underwent single plate fixation and 8 underwent dual plate fixation. There were no significant differences in demographics, number of co-morbidities, fracture classification, or ISS between single and dual plate groups (p > 0.05 for all). There was a statistically significant difference in union rates between the single plate group (6 nonunions, 4 unions, and 3 delayed unions) and the dual plate group, with no nonunions or delayed unions (p = 0.0049). Although not statistically significant, 4 patients treated with single plating underwent revision ORIF, compared to none in the dual plating group (p = 0.13). There were no significant differences in time to follow up, time to full weight bearing, or infection rates (p > 0.1 for all).ConclusionBased on these results, the medial and lateral locked plating technique demonstrates a higher union rate, with possible lower rates of revision surgery, compared to a single lateral plate in highly comminuted distal femur fractures.Level of evidenceLevel 3. Retrospective Cohort Study.

Project description:Optimal acute management of the highly comminuted distal ulna head/neck fracture sustained in conjunction with an unstable distal radius fracture requiring operative fixation is not well established. The purpose of the present study was to determine the clinical, radiographic, and functional outcomes following acute primary distal ulna resection for comminuted distal ulna fractures performed in conjunction with the operative fixation of unstable distal radius fractures. Between 2000 and 2007, 11 consecutive patients, mean age 62 years (range, 30-75) were treated for concomitant closed, comminuted, unstable fractures of the distal radius and ulna metaphysis. All 11 patients underwent distal ulna resection through a separate dorsal ulnar incision with ECU tenodesis following surgical fixation of the distal radius fracture. According to the Q modifier of the Comprehensive Classification of Fractures, there were six comminuted fractures of the ulnar neck (Q3) and five fractures of the head/neck (Q5). Operative fixation of the distal radius fracture included volar plate fixation in four patients and spanning external fixation with supplemental percutaneous Kirschner wires in seven patients. At a mean of 42 months (range, 18-61 months) postoperatively, clinical, radiographic, and wrist-specific functional outcome with the modified Gartland and Werley wrist score were evaluated. At latest follow-up, mean wrist range of motion measured 53 degrees flexion (range, 35-60 degrees), 52 degrees extension (range, 30-60 degrees), 81 degrees pronation (range, 75-85 degrees), and 77 degrees supination (range, 70-85 degrees). Mean grip strength measured 90% of the contralateral, uninjured extremity (range, 50-133%). No patient had distal ulna instability. Final radiographic assessment demonstrated restoration of distal radius articular alignment. According to the system of Gartland and Werley as modified by Sarmiento, there were seven excellent and four good results. No patient has required a secondary surgical procedure. Acute primary distal ulna resection yields satisfactory clinical, radiographic, and functional results in appropriately selected patients and represents a reliable alternative to open reduction and internal fixation when anatomic restoration of the distal ulna/sigmoid notch cannot be achieved. Primary distal ulna resection with distal radius fracture fixation may help avoid secondary procedures related to distal ulna fixation or symptomatic post-traumatic distal radioulnar joint arthrosis.

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Adjunctive intraosseous wiring fixation technique for the comminuted distal humeral fractures.

Publications

Adjunctive intraosseous wiring fixation technique for the comminuted distal humeral fractures.

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