MODERN APPROACHES TO SURGICAL TREATMENT OF INTRA-ARTICULAR COMMINUTED FRACTURES OF THE DISTAL HUMERUS
DOI:
https://doi.org/10.54890/1694-8882-2024-4-109Abstract
Intra-articular fractures of the distal humerus, despite a significant number of various modern methods of treatment, leave a high proportion of unsatisfactory results 15-40%, and patients are recognized as disabled in 18-20% of cases. Among the injuries of distal epiphysial cartilage of long bones, fractures of the distal humerus occupy a special place, representing one of the most difficult problems of fracture treatment. Making up a rather significant part of all intra-articular fractures (19%), they often lead to the impossibility of self-care due to very modest functional results of treatment and a high number of complications, which, according to various data, are up to 67%. Fractures of the distal humerus are from 0.5% to 15.3% of all humerus fractures and are a rather severe injury both in the system of their treatment and in terms of predicting long-term functional results due to the polymorphism, difficulty of repositioning and ensuring reliable fixation of the fragments. The accuracy of repositioning and stability of the external fixation determines the possibility of early functional rehabilitation of the elbow joint in the postoperative period, which ultimately has an exceptional value in the professional and domestic reintegration of the patient. The issues of treatment of patients with fractures of distal humerus remain relevant for modern traumatology due to the high number of unsatisfactory treatment outcomes, which is up to 60%.
Keywords:
humerus, fracture, condyle, osteosynthesis, repositioning, fixation, rehabilitationReferences
1. Morrey ME, Morrey BF, Sanchez-Sotelo J, Barlow JD, O'Driscoll S. A review of the surgical management of distal humerus fractures and nonunions: From fixation to arthroplasty. J Clin Orthop Trauma. 2021;20:101477. https://doi.org/10.1016/j.jcot.2021.101477
2. Bucholz RW, Heckman JD, Court-Brown CM. Rockwood and Green’s fractures in adults, 7th edition. Philadelphia: Lippincott Williams and Wilkins; 2010. 2174 p.
3. Кутепов С.М., Волокитина Е.А., Гилев М.В. Переломы дистального отдела плечевой кости. Диагностика, систематизация, лечение. Учебное пособие для врачей травматологов-ортопедов. Екатеринбург: Издательство УГМУ; 2015. 28 с. [Kutepov C.M., Volokitina E.A., Gilev M.V. Fractures of the distal humerus. Diagnostics, systematization, treatment. A textbook for orthopedic traumatologists. Ekaterinburg: USMU Publishing House; 2015. 28 p. (In Russ.)].
4. Morrey ME, Morrey BF, Sanchez-Sotelo J, Barlow JD, O'Driscoll S. A review of the surgical management of distal humerus fractures and nonunions: From fixation to arthroplasty. J Clin Orthop Trauma. 2021;20:101477. https://doi.org/10.1016j.jcot.2021.101477
5. Wang Y, Zhuo Q, Tang P, Yang W. Surgical interventions for treating distal humeral fractures in adults. Cochrane Database Syst Rev. 2013;1:CD009890. https://doi.org/10.100214651858.CD009890.pub2
6. Калантырская В.А. Лечение вне- и внутрисуставных повреждений локтевого сустава. Мир науки, культуры, образования. 2014;2:337–343. [Kalantyrskaya V.A. Treatment of extra- and intra-articular injuries of the elbow joint. The world of science, culture, and education. 2014;2:337–343 (In Russ.)].
7. Cobb T.K. Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients. J. Bone Joint Surg. Am. 1997;79:826–832.
8. Frankle MA, Herscovici D Jr, DiPasquale TG, Vasey MB, Sanders RW. A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraarticular distal humerus fractures in women older than age 65. J Orthop Trauma. 2003;17(7):473-480. https://doi.org/10.1097/00005131-200308000-00001
9. McKee MD, Veillette CJH, Hall JA, Schemitsch EH, Wild LM, McCormack R. A multicenter, prospective, randomized, controlled trial of open reduction-internal fixation versus total elbow arthroplasty for displaced intraarticular distal humeral fractures in elderly patients. J. Shoulder Elbow Surg. 2009;18(1):3–12. https://doi.org/10.1016/ j.jse.2008.06.005
10. Adolfsson L, Hammer R. Elbow hemiarthroplasty for acute reconstruction of intraarticular distal humerus fractures: a preliminary report involving 4 patients. Acta Orthop. 2006;77(5):785-787. https://doi.org/10.1080/17453670610012999
11. Jupiter JB, Neff U, Holzach P, Allgöwer M. Intercondylar fractures of the humerus. An operative approach. J Bone Joint Surg Am. 1985;67(2):226-239.
12. Бец И.Г. Особенности лечения повреждений дистального метаэпифиза плечевой кости. Травма. 2018;19(5):118-124. [Betz I.G. Features of treatment of damage to the distal metaepiphysis of the humerus. Injury. 2018;19(5):118-124. (In Russ.)].
13. Лоскутов А.Е., Доманский А.Н., Жердев И.И., Лушня С.Л. Анализ результатов хирургического лечения переломов дистального отдела плечевой кости. Травма. 2019; 1: 58-65. [Loskutov A.E., Domansky A.N., Zherdev I.I., Lushnya S.L. Analysis of the results of surgical treatment of fractures of the distal humerus. Injury. 2019;1: 58-65 (In Ukrain.)]. https://doi.org/10.22141/1608-1706.1.20.2019.158665
14. Babhulkar S, Babhulkar S. Controversies in the management of intra-articular fractures of distal humerus in adults. Indian J Orthop. 2015; 45(3):216-225. https://doi.org/10.4103/0019-5413.80039
15. Zalavras CG, Papasoulis E. Intra-articular fractures of the distal humerus-a review of the current practice. Int Orthop. 2018; 42(11):2653-2662. https://doi.org/ 10.1007/s00264-017-3719-4
16. Ring D, Jupiter JB, Gulotta L. Articular fractures of the distal part of the humerus. J. Bone Joint Surg. Am. 2003;85:232–238.
17. Sanchez-Sotelo J. Complex distal humeral fractures: internal fixation with a principle-based parallel-plate technique. J. Bone Joint Surg. Am. 2007;89:961–969.
18. Sanchez-Sotelo J. Distal Humeral Fractures: Role of Internal Fixation and Elbow Arthroplasty. J. Bone Joint Surg. 2012;6:555–568.
19. Прохоренко В.М. Эндопротезирование локтевого сустава. Наука. 2010;4:79-86. [Prokhorenko V.M. Endoprosthetics of the elbow joint. The science. 2010;4:79-86. (in Russ.)].
20. Greiwe RM. 5-Proximal humerus fractures: Percutaneous fixation, proximal humeral nailing, and open reduction and internal fixation. In: Shoulder and Elbow Trauma and Complications. 2015:83–112. https://doi.org/10.1016/b978-1-78242-449-9.00005-4
21. Науменко Л.Ю., Носивец Д.С. Доступ к локтевому суставу при протезировании. Травма. 2014;3:127-128. [Naumenko L.Yu., Nosivets D.S. Access to elbow joint replacement. Injury. 2017-4;3:127-128. (in Russ.)].
22. Sanchez-Sotelo J, Ramsey ML, King GJ, Morrey BF. Elbow arthroplasty: lessons learned from the past and directions for the future. Instr Course Lect. 2011;60:157-169.
23.Скороглядов А.В., Бут-Гусаим А.Б., Морозов Д.С. Лечение внутрисуставных переломов дистального отдела плечевой кости. Тезисы докладов НИИ скорой помощи им. Н.В. Склифосовского. 2007;3:12–14. [Skoroglyadov A.V., But-Ghusaim A.B., Morozov D.S. Treatment of intra-articular fractures of the distal humerus. Abstracts of reports from the Research Institute of Emergency Medicine named after. N.V. Sklifosovsky. 2007; 3:12–14 (in Russ.)].
24. Морозов Д.С. Лечение внутрисуставных переломов дистального отдела плечевой кости [Автореферат]. Москва; 2009. 22 с. [Morozov D.S. Treatment of intra-articular fractures of the distal humerus [Abstract of the dissertation] Moscow; 2009. 22 c. (in Russ.)]