Surgical treatment of extra-articular distal-third diaphyseal fractures of the humerus using a modified posterior approach and an extra-articular plate

Abstract

Purpose: To evaluate the clinical and radiological outcomes of these fractures treated through a modified posterior approach with a distal humerus plate.

Material and methods: Between 2013 and 2015 we performed a retrospective study of these fractures surgically treated in our centre.

Inclusion criteria: older than 18 years old, no pathological fractures, follow up 1 year at least. 23 patients underwent surgery, mean age 45 years old, with an average follow-up of 18 months. Patient characteristics, aetiology and type of fractures were recorded. The surgery was performed using Gerwin modified posterior approach with a posterolateral distal humerus plate. Clinical results were evaluated using Quick DASH, MEPS, VAS. Radiological results were also evaluated. Complications associated with treatment and radial nerve palsy incidence were recorded as well.

Results: Type of fracture according AO/OTA: six 12-A, seven 12-B, ten 12-C. 23 patients progressed to union. After one year: QD 6.43, VAS 0.66, MEPS 88.88. No failure of internal fixation. Two superficial infections. 15 excellent results, 5 good, and 3 fair, with no poor results.

Conclusion: Surgical fixation of these fractures through a modified posterior approach with a posterolateral plate minimises iatrogenic nerve injury, provides better visualisation of the proximal humerus, provides stable fixation of these injuries and results in high union rates and overall excellent functional results.

Keywords: Abordaje posterior modificado; Extra-articular distal humerus fractures; Extra-articular distal humerus plate; Fracturas diafisarias húmero distal; Modified posterior approach; Placa extraarticular húmero distal.