ORIF of Distal Humerus Fractures with Modern Pre-contoured Implants is Still Associated with a High Rate of Complications

• Published in: Indian journal of orthopaedics Vol. 54; no. 5; pp. 570 - 579
• Main Authors: Patel, Shaan S., Mir, Hassan R., Horowitz, Evan, Smith, Carson, Ahmed, Adil S., Downes, Katheryne, Nydick, Jason A.
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01.09.2020
• Subjects: Conservative Orthopedics; Medicine; Medicine & Public Health; Original; Original Article; Orthopedics; Surgical Orthopedics; Complication; Distal humerus fracture; Open reduction internal fixation
• ISSN: 0019-5413; 1998-3727
• DOI: 10.1007/s43465-020-00124-4

Background The purpose of this study was to identify complications after operative treatment of distal humerus fractures with anatomic, pre-contoured, locking distal humeral plates. We hypothesized that these fractures have high complication rates despite the use of these modern implants. Materials and Methods Between 2010 and 2018, 43 adult patients with a distal humerus fracture underwent open reduction and internal fixation (ORIF) at a Level I trauma center. Pre-operative variables, including medical comorbidities, mechanism of injury, open or closed fracture, AO/OTA fracture classification (Type A, B, or C), and nerve palsy, were recorded. Intra-operative variables including surgical approach, ulnar nerve transposition, and plate configuration were recorded. Anatomic, pre-contoured, locking distal humeral plates were used in all patients. Various plating systems were used based on surgeon preference and fracture pattern. Post-operative complications including infection, nonunion, malunion, painful implants, nerve palsy, heterotopic ossification, stiffness, and post-traumatic arthritis were recorded. Results Most fractures were Type C (53%). The posterior olecranon osteotomy approach (51%) and parallel plate configuration (42%) were used in most cases. At a mean follow-up of 15 months, the complication rate was 61% (26/43 patients). Among all patients, 49% (21/43 patients) required a reoperation. Elbow stiffness (19%) was the most common complication followed by nerve palsy (16%). There were four fracture nonunions (9%), deep infections (9%), painful implants (9%), post-traumatic arthritis (9%), and heterotopic ossification (9%). Conclusions Distal humerus fractures treated with ORIF utilizing anatomic, pre-contoured, locking distal humeral plates have a high complication rate, with many requiring reoperation. Level of Evidence Therapeutic Level IV.