A Prospective Study on the Functional and Radiological Outcomes of AO Type C Distal Humerus Fractures in Adults Treated Surgically with Bicolumnar Fixation

Purpose: To study the functional and radiological outcomes of AO type C distal humerus fractures (DHFs) in adults treated surgically with bicolumnar fixation.

Methods: A prospective study of 30 adult patients with AO/OTA type C fractures of the distal humerus treated operatively with bicolumnar fixation between September 2018 to December 2020 at Sree Balaji Medical College & Hospital, Chennai was performed. Closed distal humerus fractures with intra-articular extension were fixed with bicolumnar plating, with orthogonal or parallel configuration of plate fixation decided intra-operatively. This was achieved in all patients after performing an olecranon osteotomy for better exposure of the fracture site, which was later fixed with either CC screws or K-wires with tension band wiring. The functional and radiological outcomes in this study group were assessed on regular post-operative follow-up. The Mayo Elbow Performance Score (MEPS) was used to evaluate the functional outcomes in our patients.

Results: The mean age of the patients was 44 years, with 18 (60%) males and 12 (40%) females in the study. The right-sided elbow was more frequently involved (57%) in our study. The most common mode of injury was Motor Vehicle Accident (MVA) (14 cases; 47%), while domestic fall contributed to 10 (33%) cases. Fall from height and direct trauma to the elbow made up the rest of the cases, with a 10% incidence each. A majority of cases (22 cases; 73%) showed radiological union between 12-16 weeks post-operatively, whereas 8 cases (27%) united between 17-21 weeks. The Mayo Elbow Performance Score (MEPS) used to assess the functional outcome showed excellent results in 25 (83%) cases, good and fair results in 2 (7%) cases each, and a poor outcome in 1 (3%) case.

Conclusion: For satisfactory results in intraarticular fractures of the distal humerus treated with bicolumnar plating, thorough pre-operative planning, posterior surgical approach with adequate exposure via olecranon osteotomy, anatomical inter-fragmentary stabilization by dual plating, and early post-operative mobilization with physiotherapy are important steps to be followed.