ORIF of Distal Humerus Fractures with Modern Pre-contoured Implants is Still Associated with a High Rate of Complications.

BACKGROUND

The purpose of this study was to identify complications after operative treatment of distal humerus fractures with anatomic, pre-contoured, locking distal humeral plates. We hypothesized that these fractures have high complication rates despite the use of these modern implants.

MATERIALS AND METHODS

Between 2010 and 2018, 43 adult patients with a distal humerus fracture underwent open reduction and internal fixation (ORIF) at a Level I trauma center. Pre-operative variables, including medical comorbidities, mechanism of injury, open or closed fracture, AO/OTA fracture classification (Type A, B, or C), and nerve palsy, were recorded. Intra-operative variables including surgical approach, ulnar nerve transposition, and plate configuration were recorded. Anatomic, pre-contoured, locking distal humeral plates were used in all patients. Various plating systems were used based on surgeon preference and fracture pattern. Post-operative complications including infection, nonunion, malunion, painful implants, nerve palsy, heterotopic ossification, stiffness, and post-traumatic arthritis were recorded.

RESULTS

Most fractures were Type C (53%). The posterior olecranon osteotomy approach (51%) and parallel plate configuration (42%) were used in most cases. At a mean follow-up of 15 months, the complication rate was 61% (26/43 patients). Among all patients, 49% (21/43 patients) required a reoperation. Elbow stiffness (19%) was the most common complication followed by nerve palsy (16%). There were four fracture nonunions (9%), deep infections (9%), painful implants (9%), post-traumatic arthritis (9%), and heterotopic ossification (9%).

CONCLUSIONS

Distal humerus fractures treated with ORIF utilizing anatomic, pre-contoured, locking distal humeral plates have a high complication rate, with many requiring reoperation.

LEVEL OF EVIDENCE

Therapeutic Level IV.

Informations de copyright

© Indian Orthopaedics Association 2020.

Déclaration de conflit d'intérêts

Conflict of interestDr. Hassan Mir has the following disclosures: AAOS Council on Advocacy: Board or committee member, AAOS Diversity Advisory Board: Board or committee member, AAOS Healthcare Systems Committee: Board or committee member, AO Trauma North America: Research support, AOA Leadership/Fellowship Committee: Board or committee member, Core Orthopaedics: Stock or stock Options, FOT Research Committee: Board or committee member, JAAOS Consultant Reviewer: Editorial or governing board, JBJS Consultant Reviewer: Editorial or governing board, Journal of Orthopaedic Trauma Associate Editor: Editorial or governing board, OrthoGrid: Stock or stock Options, OsteoSynthesis, The JOT Online Discussion Forum Editor: Editorial or governing board, OTA Education Committee: Board or committee member, OTA International Digital Editor: Editorial or governing board, Smith & Nephew: Paid consultant; Research support, Trice Medical: Paid consultant, Zimmer: Paid consultant. Dr. Jason Nydick has the following disclosures: Axogen: Paid consultant; Paid presenter or speaker, Checkpoint surgical: Paid presenter or speaker, DePuy, A Johnson & Johnson Company: Paid consultant; Paid presenter or speaker, Journal of Hand Surgery—American: Editorial or governing board, Mission Surgical: Paid consultant, Trimed: Paid consultant. Shaan Patel, Evan Horowitz, Carson Smith, Adil Ahmed, and Katheryne Downes do not have any disclosures. All authors contributed to the conception and design of the study, data analysis, manuscript writing, and editing.