Clinical Study Of Intercondylar Fracture Of Humerus Treated With Double Plate

Objective: To investigate the application of double plate in the treatment of clinicalcurative effect of intercondylar fractures of the humerus, analysis of factorsinfluencing postoperative recovery of elbow joint function, and share some operationskills and experience.Materials and methods: from2004August-2012year September,there are78cases of humeral intercondylar fractures were treated with double plate in ourhospital, which can be up to65cases. According to AO classification, type C113cases, type C230cases, type C3in22cases. On the left side in22cases, right in43cases;37male patients,28female patients, mean age42.5years (range of18~76year). The main causes are: falls in10cases, falling from height in13cases, trafficaccident in40cases,2cases of machine rolling.3cases with injury of the radialnerve, ulnar nerve injury in2cases.2cases were open fracture, the rest are closedfracture. Perfect preoperative examinations, including imaging (and3Dreconstruction of X-ray, CT scan). In other conditions permit, as far as possible inthe shortest time, operation treatment. The operation approach is mainly adopts thefollowing three kinds: the triceps tongue-shaped flap approach, triceps combinedapproach and olecranon osteotomy approach. Internal fixation with double platefixation. Early functional exercise under the guidance of doctors.Results: a close follow-up for patients, the follow-up including preoperative andpostoperative imaging data (X-ray, three-dimensional CT) and postoperative elbowjoint range of motion, strength and other functions. Evaluation of elbow joint functioncriteria including elbow Mayo score (MEPS), Daniels triceps muscle strengthevaluation standard, and the range of flexion, extension, elbow flexion extensionrange, pronation, supination, internal rotation and external rotation. Follow-up of65 patients for5~96months, average40.8months. All fractures achieved clinicalhealing, healing time was8weeks-19weeks, average11.8weeks,3patients had adelayed healing. There are2cases of " the triceps tongue-shaped flap approach " inpatients with decreased triceps muscle. A total of2cases occurred cubitus varus, butdid not significantly affect the function of elbow joint;5cases occurred in patientswith traumatic elbow arthritis;6patients occurred intraoperative and postoperativethe ulnar nerve injury, injury of4cases in which surgery,2cases after operation, thesymptoms disappeared4weeks after operation;3cases appeared stiff elbow joint,through8weeks of therapy after remission;4patients developed around the elbowheterotopic ossification;2cases of open fractures, the infected wound surface, in theconventional dressing the wound healing after3weeks. In5patients with nerveinjury during operation were nerve exploration and release, and the application ofneurotrophic drugs after operation,4cases recovered in6weeks,1patientsrecovered in12weeks. There is no internal fixation loosening, pullout,or broken.According to the Mayo score (MEPS),65patients were excellent in46cases, goodin11cases, fair in5cases, poor in3cases, the excellent and good rate was84.6%.(1) were compared the results are as follows according to the fracture type, patientage, operation approach: A. fracture of various types, MEPS score: excellent rate oftype C1100%, type C292.7%, type C376.4%; B. in all age groups, patients olderthan60years postoperative function recovery compared with other age difference,above60years group, the excellent and good rate is64.2%,41-59years group, therate is88%, below40years group, the rate is100%; C. three operation into thecomparison circuit, the use of the triceps tongue-shaped flap approach in patientswith follow-up showed indices were significantly lower than the other two groups.(2)the comprehensive analysis of fracture classification and operation effect of on theprognosis: A. for type C1fractures, the excellent and good rate are no difference, is100%; B. the fractures more complex, the prognosis of patients with brachial tricepstongue-shaped flap selection approach is poorer, the excellent and good rate islower; C. triceps and combined approach with respect to the olecranon osteotomy approach the excellent and good rate was slightly lower.(3) the comprehensiveanalysis of patients with age and operation effect of the excellent and good rate ofthe road: A. for aged patients older than60years, the triceps tongue-shaped flapapproach and triceps combined approach of the excellent and good rate was low(57%and60%), while the olecranon osteotomy approach with prognosis the road isbetter; B. the triceps tongue-shaped flap approach both for the patients which age,the prognosis is not ideal for all ages; C. application of olecranon osteotomyapproach for the prognosis is good, the excellent and good rate above90%.(4) theage of comprehensive analysis of patients and effect of fracture type: a.60on theprognosis of patients over age, except for type C1fractures, two other typeespecially the prognosis of type C3fractures of the poor, the excellent and good ratewas43%; in b.41-59years, with the increase of comminuted fracture or severity, theexcellent rate decreased significantly;c. under the age of40patients, the prognosisof C3fracture compared to the other two type difference.(5) anterior transpositionof the ulnar nerve group probability of ulnar nerve injury than did not reach group.(6)the excellent rate of double plate positioned vertically placed is higher than theparallel group..According to MEPS score standard excellent/good (n=57) inpatients with completely sober situation, local no tenderness, according to the score(n=5) of patients appeared mild pain; according to the score difference (n=3) ofthe patients with moderate pain.Conclusion:(1) with the development and progress of scientific theory, using thedouble plate technique in treatment of humeral intercondylar fracture has graduallybecome the consensus of everyone, and achieved good clinical results.(2) the double plate in the treatment of humeral intercondylar fractures is largelyinfluenced by the patient’s age, severity of the fracture, operation approach and earlypostoperative functional exercise influence.(3) the protection and reconstruction of the fine operation, is very beneficial to theprognosis of soft tissue. Damage or may hurt the ulnar nerve of ulnar nerve in somecases, the movement is very necessary. (4) because of the limited number of cases, follow-up data is not perfect, there arestill some to continue to study and explore.