Views: 7 Author: Site Editor Publish Time: 2022-08-18 Origin: Site
Displaced comminuted fractures of the distal humerus in adults are a difficult problem due to the complex anatomy of the elbow joint, small fracture fragments, and limited amount of subchondral bone. The lateral and medial columns of the distal humerus form a stable triangular frame. This stable triangular framework is disrupted after distal humerus fractures, especially complex AO C-type fractures.
In the AO Internal Fixation Technique book published in 1979, for comminuted fractures of the distal humerus, the AO team recommended that the plates be placed 90° to each other, one medial or lateral and one posterior (1).
a: Reconstruction of the trochlear and capitellum.
b-c: After reducing the three articular bone fragments, drill the Kirschner wire in the opposite direction. The Kirschner wire can be used as a guide wire for a 3.5mm cannulated screw, or a screw can be inserted parallel to the Kirschner wire.
d: Use temporary Kirschner wire to connect the articular bone fragment to the humeral shaft
e: To fix the articular fragment to the humerus, an anatomic LCP should first be placed on the posterior surface of the humerus, and a plate can be placed behind the capitulum without cartilage. The medial anatomical LCP can be placed on the medial crest of the humerus to enhance stability. For severe bone loss or severe metaphyseal comminution, placement of two LCPs at 90° to each other is recommended, as this configuration provides better biomechanical stability. Care should be taken to avoid penetrating the joint when using angle stabilization screws.
In the 1995 Mechanics Study Comparing Dual Plates for the Treatment of Distal Humeral Fractures, the effects of six plate placements were compared (A, dual posterior plate; B, posterior ulnar plate, lateral to radial plate; C, medial and lateral plate; D, medial to the ulnar plate, posterior to the radial plate; E, model of the medial and lateral plate with screws and four-part fracture; F, model of severe comminuted fractures with medial and lateral screws), pointing out that many fractures can be treated with double plates in different locations treatment, but for severe comminuted fractures, this study concluded that medial-lateral plate fixation combined with screw fixation significantly improves stiffness and ultimate strength (3).
Ata C (4) et al showed that a vertical plate with a posterolateral plate plus four 2.7 mm distal screws had the same stability as a parallel plate system in the treatment of intra-articular fractures of the distal humerus. Patient discomfort due to skin irritation of the lateral plate, especially thin and elderly patients, can be eliminated with the posterolateral plate.
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