| Objective Because of the special structure of distal humeral and the complex anatomical relation of peripheral tissues, it is not satisfactory in the curative effect for the distal humeral fractures, especially the complex fractures involve to joint surface and the displaced fracture obviously. It is difficult for obtained stable internal fixation to those fractures, which often leads to non-union or mal-union and the functional disturbance of the elbow joint. This article investigated the curative effect of four different internal fixation methods for the distal humeral fractures, compared the good and bad of three operative approach, and evaluated the functional restoration of elbow joint after operation.Methods From January 2004 to December 2006, thirty-three patients with the distal humeral fractures have accepted the operation, there were twenty-one male and twelve female patients. The average age at the time of operation was thirty-five years (range, fifteen～fifty-six). Thirteen fractures occurred in the left distal humeral and twenty in the right. In this group, the causes of fracture were traffic accident (twelve patients), falling injury (fifteen patients) and other causes (six). Twenty-fivepatients were fresh fractures, and eight olden fractures. According to the AO/ASIF classification, there were five cases in type A, eleven in type B, and seventeen in type C. There were twenty-five patients with closed fracture and eight with open fracture There were twelve cases fixed with single plate, two cases with Kirschner pin, nine cases with"Y"type plate, and ten with dual plate in this group. The operative procedure last 90 to 160 minutes without blood transfusion.Results The time of follow-up in this group was eight months (range, four to fifteen months). The clinical document showed that the average union time of fractures was fifteen weeks with a range of twelve to eighteen weeks. In this group, there was no case with infection and ulnar never neuropathy postoperatively, two cases with fracture non-union have treated by bone-graft and dual plate fixation, one case with heterotopic ossification by resecting and arthrolysis to cure, two cases with plate broken including one case single plate fixation and one case"Y"type plate fixation have treated by dual plate fixation. There was no case with loosen and broken in the dual plate fixation. All patients were scored by improved Cassebaum system for the elbow joint function after operation. Sixteen cases were excellent(extention 15 degrees and flexion 130 degrees), nine cases were good(extention 30 degrees and flexion 120 degrees),five were fair(extention 40 degrees and flexion 90 degrees), and three poor(extention 40 degrees and flexion 70 degrees).Conclusion Although there are many methods in treating the distal humeral fracture, the result is usually almost certain of unsatisfaction. With the further consummation of the basic investigation of fracture, the accumulation of the clinical experience, the progress of the surgical technique and the development of internal fixation, the open reduction and internal fixation(ORIF) in treating distal humeral fractures have been showing its superiority, and obtaining a good clinical effects. Of the complications have unstable fixation postoperatively, fracture non-union or mal-union, and functional defilade of elbow joint. Through the analysis and comparison of all kinds of the internal fixation methods ,we consider that the dual reconstruction plate in treating distal humeral fractures could provide an effective and durable fixation, prevent the fracture non-union or mal-union effectively, and hasten the functional recovery of the elbow joint. It is the key factors that to choice the operative approach and internal fixation method rationally, and to guide the patients exercise early in improving the result of the distal humeral fractures. In the near future, the dual reconstruction plate will be one of the main methods to treat the distal humeral fractures.
|
PDF Full Text Request