Risk factors of elbow stiffness after open reduction and internal fixation of intercondylar fracture of humerus / 中国骨伤

OBJECTIVE@#To investigate the risk factors of elbow stiffness after open reduction and internal fixation of intercondylar fracture of humerus.@*METHODS@#From March 2015 to February 2019, 120 patients with humeral intercondylar fractures were treated with open fixation including 59 males and 61 females, aged from 25 to 77 years with an average of(53.5±3.2) years. According to the occurrence of elbow stiffness after operation, 120 patients were divided into stiffness group(37 cases) and control group(83 cases). The related factors of elbow stiffness were analyzed by single factor analysis, and the risk of elbow stiffness after internal fixation of humeral intercondylar fracture was analyzed by logistic regression factor.@*RESULTS@#There were 37 cases of elbow stiffness(stiff group), and 83 cases had no elbow stiffness(control group). The incidence of joint stiffness was 30.83%. There were significant differences between the stiffness group and the control group in age, injury energy, fracture to operation time, AO classification of fracture, open injury and postoperative premature or hyperactivity. Multivariate logistic regression analysis showed that age>50 years old, high energy injury, AO classification of fracture, open fracture and postoperative premature or hyperactivity were risk factors for elbow stiffness after internal fixation of humeral intercondylar fracture. The postoperative mobility and Mayo elbow performance score(MEPS) scores of the postoperative stiffness group were lower than those of the non-stiffness group with statistical significance(P<0.05). There were no significant differences in postoperative mobility and MEPS scores between flexion stiffness and rotation stiffness after humeral intercondylar fracture(P>0.05).@*CONCLUSION@#In view of the risk factors of elbow stiffness after internal fixation of humeral intercondylar fracture, reasonable operation plan and rehabilitation strategy should be formulated before operation to minimize the incidence of elbow stiffness.

Effect of olecranon osteotomy and triceps lobe flap pedicled combined with ossylated triol on humeral intercondylar fracture and its effect on prognosis of patients / 中国生化药物杂志

Objective To evaluate the effect of olecranon osteotomy and triceps pedicel approach combined with ossylated triol in the treatment of humeral intercondylar fracture and its effect on prognosis. Methods Ninety-two patients with humeral intercondylar fractures were selected as study subjects. The patients were randomly divided into two groups: the study group and the control group. The study group selected the olecranon osteotomy for treatment. The control group selected brachial Triceps tongue tongue approach for treatment. Results The excellent and good rate of the study group was significantly higher than that of the control group (P<0.05). The mean time of operation and the time of fracture healing were significantly higher than those of the control group (P<0.05), and The data of PLT, ESR, CRP and RF in the two groups were significantly lower than those in the control group (P<0.05) , and the data of inflammatory indexes in the study group were significantly decreased (P<0.05).Conclusion The treatment of humeral intercondylar fractures with olecranon osteotomy combined with calcitriol has a direct effect. It can be seen that this treatment has a high value in clinical orthopedic treatment.

Transosseous fixation of intercondylar fracture of lower end humerus by tension band wiring technique.

Background: Intercondylar fractures of lower end of humerus is a challenge for orthopedic surgeon to fix rigidly for early mobilization. We hereby have devised a novel technique of fixing an intercondylar fracture of lower end of humerus by transosseous route utilizing the Tension band wiring. We successfully obtained a rigid, stable reconstruct without affecting the anatomy of the region. Aims & Objective: To study the effect of transosseous fixation of intercondylar fracture of lower end humerus by tension band wiring technique. Materials and Methods: We have followed a novel technique for treating intercondylar fracture of lower end of humerus. Till date we have treated 10 patients of supracondylar fracture of humerus with intercondylar extension. All patients were selected randomly the only criteria was a supracondylar fracture of lower end of humerus with intercondylar extension. This method gave us four cortices fixation in the lower intercondylar region which was not possible till date by other methods of fixation. So now T-Y elbow type of fracture is converted into a supracondylar fracture. Rest fixation of supracondylar fracture was done with perpendicular plating and k wire TBW in case of osteoporotic bones. Results: Out of 10 treated cases with this method all get rigid fixation and radiological union at average of 8 weeks. Average ROM was 5-100. One case had postoperative stitch infection, one had k wire impinging on skin and two patients lost follow up after 3 months. Conclusion: Complicated fractures of intercondylar region of distal humerus can be successfully managed by interosseous TBW technique. We recommend such technique and further research regarding it.

Surgical Treatment Using a Transolecranon Approach with a Dual Locking Plate for Unstable Intercondylar Fractures of the Humerus

PURPOSE: To evaluate the clinical outcomes of operative treatment using a transolecranon approach with a dual locking plate for unstable intercondylar fractures of the distal humerus. MATERIALS AND METHODS: Eighteen patients were followed for more than 1 year after surgical treatment for unstable intercondylar fractures of the humerus. Anterior transpositioning of the ulnar nerve and an early rehabilitation program to allow range of motion (ROM) exercise from postoperative week 1 were used for all cases. The clinical and functional evaluation was performed according to the Mayo Elbow Performance Index and Cassebaum's classification of ROM. RESULTS: The range of elbow joint motion was a flexion contracture mean of 12.8 degrees to a further flexion mean of 119.3 degrees at the final follow-up. The Mayo Elbow Performance Index was an average of 88.5 points. Among the results, 6 were excellent, 9 good, 2 fair, and 1 poor. Therefore, 15 cases (83.3%) achieved satisfactory results. Fourteen cases (77.7%) achieved a satisfactory ROM according to Cassebaum's classification. All cases achieved bone union, and the interval to union was an average of 14.2 weeks. CONCLUSION: Dual locking plate fixation through the transolecranon approach seems to be one of the effective treatment methods for unstable intercondylar fractures of the humerus because it enables the anatomical reduction and rigid fixation of articulation, and early rehabilitation exercise.

Nonunion of Humeral Intercondylar Comminuted Fracture Treated with Fibular Graft: A Case Report

Nonunion of comminuted distal humeral fracture is troublesome problem to orthopedic surgeon. We report a case of 59 years old woman, who suffered nonunion of comminuted distal humeral fracture previously treated by open reduction and internal fixation with plate and screws concomitantly autoiliac bone graft. We reconstructed humeral condyle with fibular inlay graft inside cortical shell of intercondylar bone fragment and obtained excellent result in radiological and functional outcome.

Operative Treatment of Displaced Intercondylar Fracture of the Distal Humerus with Reconstruction Plate

PURPOSE: To evaluate the therapeutic effects of chevron olecranon osteotomy and bilateral reconstruction plate as operative treatment for distal humerus intercondylar fracture. MATERIALS AND METHODS: Among patients operated for distal humerus intercondylar fracture in our hospital from June, 1997 to October, 2005, 26 patients were selected who could be followed-up for more than one year. The average follow-up period was 15 months. All olecranon osteotomies were chevron osteotomy and all fractures were treated with internal fixation using bilateral reconstruction plate. The ulnar nerve was checked in all cases. Three patients in which case the plate might irritate the ulnar nerve, received with ulnar nerve anterior transposition. Cassebaum's classification and Mayo elbow performance score were used to evaluate at three, six and twelve months. RESULTS: Mean bone union period was 11.7 weeks. There were 9 excellent cases, 11 good cases, 4 fair cases and 2 poor cases. Mean flexion contracture was 11° and further flexion was 126° at last follow-up. CONCLUSION: Bilateral reconstruction plate internal fixation using chevron olecranon osteotomy showed strong fixation and good clinical results and it is possible for early rehabilitation treatment.

Treatment of Intercondylar Fractures of Humerus with Y-plate

PURPOSE: To evaluate the results of the treatment of intercondylar fractures of the humerus using Y-plate. MATERIALS AND METHODS: The subjects were 17 patients with intercondylar fracture of humerus who were treated using the Y-plate. Nine cases were C1 type, 4 were C2 type, and the remaining 4 were C3 type. 11 subjects had accompanying fractures of another part of the body. The average age was 48.8. The average follow up period was 33 months. We used Mayo Elbow Performance Score and Risborough-Radin's rating score for each patient as the methods of rating. RESULTS: The average range of motion of the elbow was 105 degrees (50~150 degrees). According to Cassebaum's classification for elbow range of motion, 7 cases were rated very good, 1 cases were good, 4 cases were fair, and 1 cases were poor. According to Mayo Elbow Performance Score, 7 were excellent, 7 were good, 2 fair, and 1 poor. Of the 3 patients who were fair or poor in Mayo Elbow Performance Score, 2 were type C3 fractures, and all 3 had major accompanying fractures. No significant postoperative complications developed in all cases. CONCLUSION: The fixation with Y-plate can still be a relatively good modality of treatment for interconylar fractures of the humerus in selected cases, in spite of the known mechanical weakness of the Y-plate. The patients with severe intra-articular comminution showed relatively poor results. And we think that the age of the patient and the energy of the injury have more or less influence on the results of treatment.

Comminuted Intercondylar Fracture of the Distal Humerus in Adults

PURPOSE: To evaluate the therapeutic results of communited intercondylar fractures of the distal humerus that were treated by surgical treatment. MATERIALS AND METHODS: From January, 1998 to December, 2004, we reviewed fifteen cases of intercondylar fracture of the distal humerus, which were treated by surgical treatment. The follow up period ranged from six month to 5 years. The functional results were evaluated using Broberg and Morrey's functional scale according to surgical approach, type of plate and location of plating. RESULTS: The functional results were as follows; seven excellent, six good, one fair and one poor. The mean range of motion in elbow joint was 7~106 degrees. The mean functional score was 86.6 points through olecranon osteotomy, 90.5 points through Campbell's posterior approach. The mean functional score was 91.6 points in cases using 2 reconstruction plate, 78 points in cases using 1 reconstruction plate and 1/3 semitubular plate, and 86 points in case using 1 reconstruction plate and lag screws. The mean functional score was 88.9 points in cases by posterior and lateral fixation, 86 points in cases by both posterior fixation and 97 points in case by both lateral fixation. CONCLUSION: There are no significant differences in treatment outcome according to surgical approach, different plate and location of plating.

AO double plates in internal fixation of humeral intercondylar fractures / 中国矫形外科杂志

[Objective]To study the effects of AO double plates in internal fixation of humeral intercondylar fractures and to analyze the causes of the disfunction in elbow.[Method]From March 2001 to March 2006,21 cases (male 14, female 7) of humeral intercondylar fractures were reviewed, with an average age of 35.3 years (ranged,15～64 years).Left elbow:9 cases;right elbow:12 cases.According to AO/ASIF classification,type C1∶6,type C2∶10, and type C3∶5,2 cases of all were open fractures. Posterior operating approach of elbow: trans-olecranon osteotomy or trans-triceps-side approach and internal fixation by standard method of AO double plates were performed in all cases.The patients began the active training of elbow joint as soon as possible postoperatively.[Result]Twenty-one cases were followed up for 8～38 months and the average time was 14.8 months.Bone union was obtained in all cases.One case complicated wound infection,it recovered after 3 weeks of dressing.And 1 case complicated with radial nerve injury,which recovered with neural nutrients.According to the Cassebaum scoring system,the effects were evaluated as excellent 7,good 10,and fair 4,and the excellent-good rate was 80.9%.[Conclusion]The application of AO double plates was proved to be a good method to treat humeral intercondylar fractures at present. But the severity of the bone comminution and soft-tissue lesion, the effective fixation,earlier active exercise were the main causes that influence the functional recovery of elbow joint.

Closed reduction and trans-cuteneous screw and Kirschner's wire fixation to treat intercondylar fracture of humerus / 中国矫形外科杂志

[Objective]To explore the methods and effects of closed reduction and percutaneous internal fixation to treat intercondylar fractures of humerus.[Method]From 2001,3 to 2004,9 we selectively treated 6 cases(group A) of Rise-Borough Ⅱ,Ⅲ type of humeral intercondylar fractures with closed reduction and percutaneous internal fixation with hollow screw and Kirschner's wire.Others(group B) treated with opened reduction and internal fixation with plates and screws.[Result]Following up 6～12 months,the outcome were evaluated with Aitken and Rorabeek rating system.Group A:5 patients were graded as excellent,1 as good.Group B:7 patients were graded as excellent,7 as good,1 as fair,1 as poor.[Conclusion]To treat Rise-Borough Ⅱ,Ⅲ type of humeral intercondylar fractures with closed reduction and percutaneous internal fixation with hollow screw and Kirschner's wire,can decrease iatrogenic impairment,receive reliable fixation and early functional exercise.The fracture union quickly,and the patient has excellent joint function and less postoperative complication.

Intercondylar Fracture of Distal Humerus in Children

Intercondylar fractures of the distal humerus are very rare in children. The pattern of the fracture would suggest that the mechanism of injury involves a fall directly on the flexed elbow. Most agree that the undisplaced fracture can be managed conservatively. With increasing displacement and comminution, the opinions tend to differ. We suggest that closed reduction with percutaneous K wire pinning and open reduction with percutaneous K wire pinning offer a satisfactory methods by which to treat displaced intercondylar fracture in children.

Clinical Outcome of Surgical Treatment of Distal Humerus Intercondylar Fractures Through the Transolecranon Approach Combined with Anterior Transposition of the Ulnar Nerve

PURPOSE: To analyze the clinical outcomes of surgical treatment of distal humerus intercondylar fractures through the transolecranon approach combined with anterior transposition of the ulnar nerve. MATERIALS AND METHODS: Eight patients who had distal humerus intercondylar fractures were included in this study and underwent operative treatment through the transolecranon approach for sufficient operative field with anterior transposition of the ulnar nerve and fixed with reconstruction plate. RESULTS: The results were evaluated using Riseborough and Radin rating criteria. Seven cases of eight cases were achieved good results with flexion contracture less than 30 degrees and forward flexion more than 115 degrees. However, one case was acheived poor result with 40 degrees of flexion contractue and 70 degrees of forward flexion. There were no the compressive ulnar neuropathy. CONCLUSION: We found the transolecranon approach and anterior transposition of the ulnar nerve a viable option for surgical treatment of the distal humerus intercondylar fractures

Treatment of Supracondylar-Intercondylar Femoral Fractures with a Retrograde Intramedullary Nailing

PURPOSE: We analyzed the cases of supracondylar-intercondylar femoral fracture treated with retrograde intramedullary nail and report the clinical results and its usefulness. MATERIALS AND METHODS: We reviewed 17 cases of supracondylar-intercondylar femoral fracture that had been treated with retrograde intramedullary nail and each of patients had been followed up for a minimum one year. Post-operative functional assessment was performed using a scale developed by Sanders et al. The evaluation scale assesses range of motion, pain, walking ability, return to work, and alignment and shortening as measured on radiograph. RESULTS: According to functional assessment of Sanders et al, there were 6 excellent, 9 good, 1 fair, and 1 poor results, that is, 94% showed above excellent results. Bony union was obtained in average 5 months after operation. The post-operative complications were varus deformity in 1 case, wound infection in 1 case, stiffness of knee joint in 1 case, and metal failure in 1 case. CONCLUSION: The treatment of supracondylar-intercondylar femoral fracture with retrograde intramedullary nail is one of the good surgical options for clinically preferable results with the advantages in early joint motion and early ambulation.

Surgical Treatment of Intercondylar Fracture of the distal Humerus through the Modified Triceps Sparing Approach / 대한정형외과학회잡지

PURPOSE: We evaluated the therapeutic results of intercondylar fractures of the distal humerus that were treated through the modified tricepssparing approach. MATERIALS AND METHODS: From February, 1997 to september, 2001, we reviewed sixteen cases of intercondylar fracture of the distal humerus, which were treated by surgical treatment. The follow up period ranged from one year to three years, averaging 1 year 8 months. The articularsurface of the distal humerus was exposed through elevation of the triceps from the medial and the lateral intermuscular septum. Theulna nerve was identified and protected, and then, the fracture sites were fixed with double plates. The functional results were evaluated using Broberg and Morrey's functional scale. RESULTS: All united at 14.5 weeks in an average. The functional results were as follows; three excellent, ten good, two fair and one poor. The range of the elbow joint motion was flexion contracture 11 degree to further flexion 130 degree in average. The one patient presented poor result had coronal shear fracture of the capitulum combined with severe comminution. The incomplete ulnar nerve palsy developed in one case. CONCLUSION: The modified triceps sparing approach provided sufficient exposure for rigid fixation of intercondylar fracture of the humerus. But in cases with severe comminution or coronal shear fracture, additional anterior approach or olecranon osteotomy should be considered.

Retrograde intramedullary interlocking nail for the treatment of femoral supracondylar of intercondylar fractures with femoral shaft fractures / 中国综合临床

Objective To assess the clinical outcome of retrograde intramedullary interlocking nail in the treatment of femoral suplracondylar or intercondylar fracture with femoral shaft fracture.Methods 3 cases of femoral supracondylar fracture with femoral shaft fracture and 6 cases of intercondylar femoral fracture with femoral shaft fracture experienced the fixation with retrograde intramedullary interlocking nail.Results The patients were followed up for 7～ 20 months,on an average of 10 months.All the patients recovered in an average time of 6 months,with excellent knee joint movement.Conclusion Retrograde intramedullary interlocking nail has obvious advantages in the treatment of femoral supracondylar or intercondylar fracture with femoral shaft fracture and the clinical outcome is satisfactory.

Lateral Plate Fixation in Intercondylar Fracture of the Humerus / 대한정형외과학회잡지

PURPOSE: We reviewed the efficiency of the lateral plate fixation in 15 cases of intercondylar fracture of the humerus. MATERIALS AND METHODS: Fifteen patients was treated by open reduction and internal fixation with lateral plate for intercondyle fracture of humerus. Plate was applied along the lateral aspect of the lateral column and lag screw was inserted in the medial column through the plate. When instability of the medial column was persisted after lateral plating, medial plate was applied posteriorly. RESULTS: There were nine C2 fracture and six C3 fracture by AO/ASIF classification. All of them had comminution at the lateral column. All fractures united at 18.7 weeks in average (range, 10-28 weeks) . Seven cases presented limitation of motion of the elbow joint and five of them underwent adhesiolysis of elbow joint. Finally, range of motion of the elbow joint was flexion contracture 16 degree to further flexion 127 degree in average. Elbow function was classified as thirteen excellent or good, one fair, and one poor. CONCLUSION: In this study, lateral plating with or without medial plate provided suffient rigidity for early motion and was worthful for treatment of the comminuted intercondylar fracture of the humerus.

Surgical Treatment of Supra and Intercondylar Fracture of the Femur / 대한정형외과학회잡지

We performed a retrospective analysis of the results of surgical treatment of sixteen patient with comminuted fracture of the distal femur from September 1993 to August 1995 and evaluated the efficacy of the angled blade plate as one of the fixation devices used. The fractures were limited to C2 and C3 fracture classifed according to the AO classification. After an average follow-up of 13 months (range, 9 to 24 months), all of the fractures had healed. Postoperatively, the arc of flexion was limited between 90degrees and 125degrees in eight, normal arc in five, and severely restricted arc of joint motion was present unexceptionally in three patients with deep infection. In angular deformity, average 5.8degrees of valgus and 2.4degrees posterior angulation were showed. The functional results by Sanders-Swiontkowski-Rosen-Helfet rating system were showed excellent in 3, good in 7, fair in 3, and poor in 3 cases. The overall results were seen to be excellent to good in ten cases (62.5%) but in twelve patients using the angled blade plate, excellent to good results were showed 10 patients (83.3%). We attribute the favorable results in our series to restoration of the articular surface through the modified extensile approach, sufficient stable fixation using the angled blade plate with conforming to the concept of bridge plate, routinely performing the bone graft for medial buttress and bone healing, and early mobilization of the extremity.

Interlocking Intramedullary Nailing for Supracondylar & Intercondylar Fracture of the Distal Part of the Femur / 대한정형외과학회잡지

The conventional therapy for supracondylar fracture of the femur is open reduction and internal fixation with plate and screws. But, wide dissection of the thigh with the following devascularization of the distal femur caused a high incidence of complications like joint stiffness, delayed union, nonunion, infection and loosening or breakage of plate and screws. On the contrary, interlocking intramedullary nailing does not need the exposure of the fracture so that soft tissue dissection and devascularization can be minimized. Undoubtedly, rapid healing by abundant formation of callus is promoted, irrespective of the degree of comminution. We reviewed 9 cases of interlocking intramedullary nailing for supracondylar and intercondylar frtures of the distal part of the femur at Pusan National University Hospital from November 1993 to December 1995. The mean time to union was 14 weeks (range, 11-23weeks). According to Rating System of Neer et al., excellent was 7 cases, satisfactory in 1 case and unsatisfactory in 1 case. Interlocking intramedullary nailing was applied to Type A, C1 and C2 of the AO classification but considered difficult to apply to Type B and C3. For the firm fixation and the prevention of nail breakage, the nail should be inserted deepest in order to place two distal screws as distally as possible from the fracture site. If necessary the distal tip of nail was cut off for use. Interlocking intramedullary nailing does not need the exposure of fracture site. Satisfactory result could be obtained by reducing complications such as joint stiffness, delayed union, nonunion, infection and breakage of implants caused by wide dissection of the thigh with the following devascularization of the distal femur for the open reduction and internal fixation with plate and screws. It also could be obtained by performing early ROM exercise with firm, fixation.

Biomechanical comparison of three internal fixation methods for intercondylar fracture of humerus / 解放军医学杂志

Objective A biomechanical comparison of three kinds of internal fixation for intercondylar fracture of humerus was, made so as to provide a theoretical basis for clinical practice. Methods 18 fresh humeri were used to reproduce T-type intercondylar fracture, and three different fixation appliances were applied, including cross Kirschner wire with addition of “8” wire, single “Y” type plate, 1/3 tubular plate with reconstruction plate. Biomechanical tests were performed on these specimens. Result Under the same load condition, 1/3 tubular plate with reconstruction plate yielded the best results, while crossing Kirschner wire with “8” wire was the poorest. Conclusion The results showed that 1/3 tubular plate with reconstruction plate was a good internal fixation appliance. It has a proper design and stability, but it is not easy to apply. Therefore, an optimal method should be chosen according to local condition in clinical practice.