To evaluate the outcome of posterolateral plate in distal humerus fracture
Authors: Sharma Brijesh , Shakunt Rajendra Kumar , Kumar Atul , Patel Jaydeep , Gahlot Surendra , Pal Chandra Prakash Prakash 
Published: December 2023

Abstract

Background:
Extra-articular distal humerus fracture accounts for approximately 16% of humerus fractures and 3% of all fractures in adults. There is good evidence that the overall incidence of distal humerus fractures is increasing worldwide. There is a bimodal distribution concerning age and gender, with peaks of incidence in males aged 12–30 years and females aged 60 years and over. Fractures of the distal third of the humerus are challenging injuries due to their peri-articular location, the small size of the distal bone fragments, and the osteopenic quality of the bone in older adults. In this era of modern orthopedics, despite various advances, distal humeral fractures remain one of the most challenging injuries to treat. Extraarticular fractures of the distal humerus occur at an anatomical watershed between the humerus shaft and the intercondylar region. These injuries are often displaced and have complex fracture patterns with associated comminution. The aim of our study is to evaluate the outcome of the posterolateral plate in distal humerus fracture.

Materials and Methods:
This prospective study will be hospital based, and will be conducted at our center from September 2021 to May 2023. Patients will be selected from the emergency and outpatient departments of our college. Assessment of functional status will be done using Mayo Elbow Performance Score at 6 months postoperatively. Assessment and analysis of any complications were done in terms of loss of reduction, problems of union, and implant failure.

Results:
Out of 35 operated patients only 30 qualified to be included in this study. Patient demographics, mode of injury, side involved, soft tissue status, pre-operative radial nerve status, AO type of the fracture, associated injuries, and the time interval between injury and surgical intervention were recorded. During follow-up, the course of fracture healing will be documented radiologically (with a minimum of 6 weeks between successive radiographs). Evaluation of any possible loss of reduction that might occur, compared with the immediate post of radiographs. Assessment of functional status will be done using Mayo Elbow Performance Score at 6 months postoperatively. Radiological misalignment, especially varus deformities followed by apex posterior angulations was the most common deformity, though not clinically evident. Surgical fixation carries the advantage of restoration and maintenance of alignment of the fracture fragments and quick return of function. However, surgical fixation is plagued with complications like non-union, radial nerve palsy, infection, and hardware symptoms.

Conclusion:
In summary, treating extraarticular distal humeral fractures with plate osteosynthesis is often challenging because of the risk of centrally located posterior plates impinging on the olecranon fossa limiting distal inadequate fixation and leading to loss of fixation many times. The use of these posterolateral locking compression plate obviates this problem. The distal aspect of the plate contour around the lateral column allows for the insertion of up to five locking screws into the distal fragment. Out of 35 patients, 30 patients had complete follow-up, and only two patients needed revision of plating and bone grafting.