Paratricepital Approach for Fixation of Distal Humerus Fractures in Adult – A Review of Thirty Cases

Background: Distal humerus fractures are most commonly managed by surgical approaches that disrupt the extensor mechanismof the elbow. Paratricepital approach for distal humerus fracture fixation has been done by orthogonal or parallel plate constructthat allows excellent healing of fracture, motion arc of elbow more than 100°, and maintains of extensor mechanism strength.Materials and Methods: Atotal of 30 cases of distal humerus fractures are fixed by paratricepital posterior approach. Bicolumnerfixation done by elevating and retracting the triceps of the distal humerus keeping triceps insertion undisturbed by orthogonalor parallel plate construct. Early active-assisted range of motion initiated within limits of pain. The age group was 15–60 years.Among them 21% was Type A fracture, 17% Type B fracture, 33% Type C1 fracture, and 29% Type C2 fracture. More than60% of cases have 1 year of follow-up. Radiograph and functional evaluation were done by mayo elbow performance score(MEPS), disability of arm, shoulder, and hand questionnaire.Results: All 30 fractures healed primarily. The median arc of elbow motion was 105° (range 70°–140°). Average MEPS was91 points (range 65–100) indicating excellent scores.Conclusion: Treatment of distal humerus fracture in adults by paratricepital posterior approach results in excellent healing, amean flexion extensor arc more than 100°, maintains of almost normal elbow extensor strength compared with the contralateralnormal elbow.

Clinical Outcome of Monostotic Fibrous Dysplasia Over Proximal Femur Treated with Intramedullary Nailing and Bisphosphonate Therapy

Introduction: Fibrous dysplasia (FD) of bone is an enigma with no proper guideline. Treatment currently consists of curettageand bone grafting in an attempt to eradicate the lesion and to prevent progressive deformity. No definite criteria have beenestablished to identify patients at high risk of presenting pathological fractures.Purpose: The purpose of the study was to explore the effect of combination bisphosphonate therapy in diminishing pain,preventing fractures, lowering N-telopeptide values, and leading to partial resolution of FD lesions.Materials and Methods: At Medical College, Kolkata, 10 patients with monostotic FD in lower extremities were treated between2014 and 2018 and included in the study. All patients underwent full skeletal survey followed by core needle biopsy with the helpof magnetic resonance imaging and C-arm guidance. After confirmation, closed intramedullary nail without reaming was usedin all cases. Bone grafting was not performed. Zoledronic acid was given intravenously at the dose of 4 mg every 6 months.Patients were allowed full weight-bearing on the affected extremities on the 2nd post-operative day.Results: Seven patients were female and three were male; their mean age was 26.9 years. The mean duration of follow-upwas 30.5 months. We get good to average results. Clinicoradiological improvement of all cases was observed.Conclusion: As a result of this study, we believe that intramedullary fixation can be performed successfully. Treatment ofmonoostotic fibrous dysplasia with adjuvant bisphosphonate therapy resulted in effective pain control and early return offunctional activity. This will avoid problems that may occur following pathological fractures.