Surgical treatment of comminuted intra-articular fractures of the distal humerus with double tension band osteosynthesis

Headnote

ABSTRACT

Intra-articular fractures of the distal humerus are usually treated with cancellous screws for the condylar metaphysis itself and two Y-shaped plates for fixation of the metaphysis to the shaft. Twenty-four patients with comminuted intra-articular fractures (class C on AO/ASIF classification) were treated with crossed K-wires for the condylar metaphysis and double tension band osteosynthesis for fixation of the metaphysis block to the shaft. Excellent or good results were achieved in 83% of patients. This technique is easier to perform and more cost effective than most other fixation methods. Additionally, it offers good stability and allows for earlier functioning of the elbow. Complication rates are comparable to other methods of internal fixation.

The best method of treatment for comminuted intra-articular fractures of the distal humerus has long been subject to debate, particularly when the fractures occur in patients with osteoporosis. Conservative treatment usually results in loss of elbow movement and permanent disability.

In general, any treatment for fractures that requires prolonged immobilization risks loss of elbow function from fibrosis or ankylosis of the joint. ' 3 In the 1960s, a more aggressive approach that resulted in rigid internal fixation, anatomical reduction, and early postoperative joint movement was adopted. Since then, the functional results have improved.4

A review of the literature shows the fixation technique used most frequently in the past decade was that advocated by the AO: reconstruction of the metaphysis block using one or more cancellous screws and fixation of the metaphysis to the humeral shaft using plates. As pointed out by many authors, treating distal humeral fractures can be difficult. The difficulties can originate from the architecture of the distal humerus or most often from a combination of comminution and osteoporosis.

Mechanical failure of fixation is common in patients with severe comminution and displacement (C2, C3 type according to AO/ASIF classification5), whether or not the fractures occur in osteoporotic bone. Henley6 reported 5 cases of implant breakage in a group of 33 patients. Sodergard et al7 reported a 29.5% mechanical failure rate in 18 cases and advised a nonsurgical approach when the bone is osteoporotic.

This study evaluated 24 patients with comminuted intra-articular fractures (class C on AO/ASIF classification) treated with double tension band osteosynthesis.

MATERIALS AND METHODS

Patient Population

Since...