Outcome after the surgical treatment of the Dubberley type B distal humeral capitellar and trochlear fractures with a buttress plate.

OBJECTIVE: This study aimed to evaluate the functional outcomes of the surgical treatment performed with a buttress plate for the trochlear and distal capitellum fractures with posterior extension in the humerus. METHODS: The data belonging to 6 female and 4 male patients with a mean age of 43.8±11.1 (34-72) years were retrospectively evaluated. The mean follow-up period was 59.6±38.79 (22-127) months. The trochlear extension and posterior comminution of the fractures were assessed through the initial X-rays and computerized tomography images. Ten patients were classified as Dubberley type B. All fractures were treated surgically, with open reduction and internal fixation using a lateral buttress plate, headless cannulated screws, and Kirschner (K)-wires. The passive flexion and extension exercises were initiated at the first postoperative day. The patients were evaluated clinically and radiographically at the final follow-up. The outcomes were quantified using the Mayo Elbow Performance Index (MEPI), visual analog scale (VAS) pain score, and the patient's opinion. RESULTS: At the final follow-up, the mean elbow flexion was 137.5°±3° (132°-140°), extension was -17.9°±9.2° (10°-35°), pronation was 72.2°±2.6° (68°-75°), and supination was 78.9°±4.09 (72°-85°). The mean MEPI score was calculated as 95.5±5.98 (85-100). According to the MEPI score, 8 patients were evaluated as excellent and 2 as good. The mean VAS pain score was 0.8±1.03 (0-2). The subjective patient evaluation was recorded as excellent in 5 patients, good in 3 patients, and moderate in 2 patients. One patient developed avascular necrosis and 2 patients had elbow joint arthrosis. K-wire migration was observed in one patient. Loss of reduction, nonunion, malunion, reflex sympathetic dystrophy, or heterotopic ossification were not encountered. CONCLUSION: The management of distal humeral fractures is challenging, and favorable outcomes are closely associated with early joint motion. A solid fixation grants early mobilization. An internal fixation using lateral buttress plate, headless cannulated screws, and interfragmentary K-wires provides a solid and secure construction that allows early postoperative joint motion. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

The midterm and long-term effects of acetabular roof ring and Burch-Schneider anti-protusio cages in acetabular revisions for patients with acetabular bone deficiency.

OBJECTIVE: The purpose of this study was to investigate the mid-term and long-term effects of the acetabular roof ring (ARR) and Burch-Schneider anti-protrusio cage (BSAPC) in acetabular revision for patients with acetabular bone deficiency and acetabular component loosening. METHODS: Between 1988 and 2007, ARR revisions were performed in 51 patients (25 women; average age: 46.9 years) and BSAPC in 18 patients (16 women; average age: 62.1 years). Grafts were used in all revisions. The patients were evaluated retrospectively. The bone defects were classified according to the classification of the American Academy of Orthopaedic Surgeons (AAOS). Harris Hip Score (HHS) was used for clinical evaluation. Radiolucent lines, implant sizes, osseointegration, and heterotopic ossification in the 3 regions defined by DeLee and Charnley were evaluated radiologically. RESULTS: The success rate of ARR revisions after an average follow-up of 8.93±4.10 years (range: 4-23 years) was 87.9%, and the cumulative survival rate at year 10 postoperatively was 91%. Average HHS score increased to 83.70±8.98 postoperatively, from 40.10±2.49 preoperatively (p<0.01). The success rate of BSAPC revisions after an average follow-up of 7.06±2.39 years (range: 4-12 years) was 83.3%, and the cumulative survival rate was 78%. Average HHS score increased from 42.55 preoperatively to 73.86 postoperatively (p<0.01). All failures of ARR revisions occurred in type 3 defects (p<0.05). In 40 of the 47 patients in which an allograft was used, osseointegration occurred. No statistically significant difference was found between the increase in HHS scores of patients who underwent femoral component revision with acetabular revision and those who did not (p=0.06). Patients who underwent more than 1 revision had statistically significantly higher failure rates in comparison to patients undergoing revision for the first time (p=0.008). CONCLUSION: The mid-term and long-term results of the use of ARR and BSAPC with allografts in bone deficient acetabular revisions are satisfactory. The implants facilitate graft osseointegration, increase the bone stock, and make future revisions easier. ARR should be preferred in type 1 and type 2 acetabular bone defects, while BSAPC should be preferred in type 3 and 4 defects.