Treatment of patients with complicated fractures of the distal humerus using the fixators of limited-contact multiplanar osteosynthesis

Authors

  • Petro Bilinskyi National Medical University named after O. O. Bogomolets, Ministry of Health of Ukraine, Kyiv

Keywords:

Complicated fractures of the distal humerus, devices for limited-contact multiplanar osteosynthesis

Abstract

Treatment of distal humerus fractures is a complex problem in traumatology. The result of treatment depends on the choice of fixator according to the fracture area. Objective. To improve the techno­logy of treatment in patients with complicated distal humerus fractures with fixators of small contact and multiplanar osteosynthesis and to evaluate its efficacy. Methods. 39 patients were treated for the period 2000–2020 with distal humerus nonunion (types 12-B1, 12-C1, 12-C2) and 23 patients with complicated above- and transcondylar humerus fractures (types 13-A2, 13-C1, 13-C2). Fixation of bone fragments of the distal humerus was made with device for fixation (Patent 17502 UA). It is a shaped plate with a groove on which half rings with threaded holes are stabilized. For the osteosynthesis of above- and transcondylar humerus fractures we used V-shaped plate with the possibility to regulate branch spreading width as for the condylar size (Patent 33358 UA). Autografting was performed as for necessity. Results. Plate osteosynthesis was performed mainly through anterior approach with minimal tissues traumatization. Release of radial nerve we made as for necessity. This device provides the stable fixation even in a case of short distal fragment. Device for bone fragments fixation was placed on the posterior condylar surface and lower part of the humerus through olecranon osteotomy. Osteosynthesis with suggested device is one of the options with bone autografting and can be method of choice at repeated surgery. Follow-up period was 1–2 years and later. In 60 patients we obtained good results with completed bone union. Conclusions. Suggested device can be used in cases of distal humerus nonunion. It allows to decrease the damage of surgery, to avoid many complications. Key words. Complicated fractures of the distal humerus, devices for limited-contact multiplanar osteosynthesis.

Author Biography

Petro Bilinskyi, National Medical University named after O. O. Bogomolets, Ministry of Health of Ukraine, Kyiv

Doctor in Traumatology and Orthopaedics

References

Bodnya, A. I., Slavov, V. Kh., & Krivenko, S. N. (2010). Apparatus for external osteosynthesis of fractures of the distal third of the humerus. Orthopedics, Traumatology and Prosthetics, 4,60–64. https://doi.org/10.15674 / 0030-59872010460-64. [in Russian]

Matelenok, E. M. (2000). Determination of indications for surgical and conservative treatment for intra-articular fractures of the condyle of the humerus. Orthopedics, Traumatology and Prosthetics, 4, 99–104. [in Russian]

Loskutov, O. E., Domansky, A. M., Zherdev, I. I., & Lushnya, S. L. (2019). Analysis of the results of surgical treatment of fractures of the distal humerus. Trauma, 20(1), 32–36. https://doi.org/10.22141/1608-1706.1.20.2019.158665. [in Ukrainian]

Morozov, D. S. (2009). Treatment of intra-articular fractures of the distal humerus. [Unpublished PhD dissertation]. [in Russian]

Galano, G. J., Ahmad, C. S., & Levine, W. N. (2010). Current treatment strategies for Bicolumnar distal humerus fractures. American Academy of Orthopaedic Surgeon, 18(1), 20-30. https://doi.org/10.5435/00124635-201001000-00004

Klenin, A. A., Korolev, S. B., Nosov, O. B., & Veshutkin, V. D. (2014). Clinical and morphological assessment of stable osteosynthesis of fractures of the capitate eminence of the humerus and their consequences in adults. The Genius of Orthopedics, 1, 77–83. [in Russian]

Golka, G. G., Palamarchuk, V. V., & Bulavin K. A. (2010). Experience of using plates with angular stability in the treatment of intra-articular fractures. Trauma, 11(4), 421–425. [in Russian]

Nosivets, D. S., & Naumenko, L. Yu. (2013). Analysis of errors and complications in the treatment of fractures of the distal metaepiphysis of the humerus. Materials of Ukrainian scientifical and practical conference “Modern theoretical and practical aspects of traumatology and orthopedics”. [in Russian]

Deuel, C. R., Wolinsky, P., Shepherd, E., & Hazelwood, S. J. (2007). The use of hinged external fixation to provide additional stabilization for fractures of the distal humerus. Journal of Orthopaedic Trauma, 21(5), 323-329. https://doi.org/10.1097/bot.0b013e31804ea479

Bets, G. V., Cherepov, D. V., Bets, I. G., & Stoiko, I. V. (2016). General tactical principles of treatment of fractures of distal metaepiphyses of long bones. Orthopedics, Traumatology and Prosthetics, 1, 109–114. https://doi.org/10.15674/0030-598720161109-114. [in Russian]

Bets, I. G. (2018). Tactical and technological features of treatment of damage to the distal metaepiphysis of the femur. Trauma, 19(2), 122–128. https://doi.org/10.22141/1608-1706.2.19.2018.130658. [in Ukrainian]

Bilinsky, P. I. (1997). Device for fixing bone fragments. Ukraine. Patent 17502 UA. [in Ukrainian]

Bilinsky, P. I., & Kovalchuk, M. V. (2001). Device for osteosynthesis (options). Ukraine. Patent 33358 UA. [in Ukrainian]

Volna, A. A., Panin, M. A., & Zagorodniy, N. V. (2009). Removal of metal structures: a solved problem? Orthopedics, Traumatology and Prosthetics, 4, 84–87. https://doi.org/10.15674/0030-59872009484-87. [in Russian]

Published

2021-05-18

Issue

Section

ORIGINAL ARTICLES