Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 12 , ISSUE 1 ( April, 2017 ) > List of Articles

Original Article

Retrospective analysis of extra-articular distal humerus shaft fractures treated with the use of pre-contoured lateral column metaphyseal LCP by triceps-sparing posterolateral approach

Yatinder Kharbanda, Yashwant Singh Tanwar, Vishal Srivastava, Vikas Birla, Ashok Rajput, Ramsagar Pandit

Keywords : Distal humerus fracture, Extra-articular distal humerus LCP, Posterolateral approach humerus

Citation Information : Kharbanda Y, Tanwar YS, Srivastava V, Birla V, Rajput A, Pandit R. Retrospective analysis of extra-articular distal humerus shaft fractures treated with the use of pre-contoured lateral column metaphyseal LCP by triceps-sparing posterolateral approach. 2017; 12 (1):1-9.

DOI: 10.1007/s11751-016-0270-6

License: CC BY-NC-SA 4.0

Published Online: 30-04-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Management of extra-articular distal humerus fractures presents a challenge to the treating surgeon due to the complex anatomy of the distal part of the humerus and complicated fracture morphology. Although surgical treatment has shown to provide a more stable reduction and alignment and predictable return to function, it has been associated with complications like iatrogenic radial nerve palsy, infection, non-union and Implant failure. We in the present series retrospectively analysed 20 patients with extra-articular distal humerus shaft fractures surgically treated using the extra-articular distal humeral locking plate approached by the triceps-sparing posterolateral approach. The outcome was assessed using the DASH score, range of motion at the elbow and the time to union. The mean time to radiographic fracture union was 12 weeks.

PDF Share
  1. Horne G (1980) Supracondylar fractures of the humerus in adults. J Trauma 20:71-74
  2. Aitken GK, Rorabeck CH (1986) Distal humeral fractures in the adult. Clin Orthop 207:191-197
  3. Sarmiento A, Horowitch A, Aboulafia A, Vangsness CT Jr (1990) Functional bracing for comminuted extra-articular fractures of the distal third of the humerus. J Bone Joint Surg Br 72(2):283-287
  4. O'Driscoll SW, Spinner RJ, McKee MD, Kibler WB, Hastings H 2nd, Morrey BF et al (2001) Tardy posterolateral rotatory instability of the elbow due to cubitus varus. J Bone Joint Surg Am 83-A(9):1358-1369
  5. Jawa A, McCarty P, Doornberg J, Harris M, Ring D (2006) Extraarticular distal-third diaphyseal fractures of the humerus. A comparison of functional bracing and plate fixation. J Bone Joint Surg Am 88(11):2343-2347
  6. McKee MD, Larsson S (2010) Humeral shaft fractures. In: Bucholz RW, Court-Brown CM, Heckman JD, Tornetta P III (eds) Rockwood and Green's fractures in adults, 7th edn. Lippincott William & Wilkins, Philadelphia, p 1015
  7. Prasarn ML, Ahn J, Paul O, Morris EM, Kalandiak SP, Helfet DL et al (2011) Dual plating for fractures of the distal third of the humeral shaft. J Orthop Trauma 25:57-63
  8. Paris H, Tropiano P, Clouet D'orval B, Chaudet H, Poitout DG (2000) Fractures of the shaft of the humerus: systematic plate fixation. Anatomic and functional results in 156 cases and a review of the literature. Rev Chir Orthop Reparatrice Appar Mot 86(4):346-359
  9. Gerwin M, Hotchkiss RN, Weiland AJ (1996) Alternative operative exposures of the posterior aspect of the humeral diaphysis with reference to the radial nerve. J Bone Joint Surg Am 78(11):1690-1695
  10. Hunsaker FG, Cioffi DA, Amadio PC, Wright JG, Caughlin B (2002) The American academy of orthopaedic surgeon's outcomes instruments: normative values from the general population. J Bone Joint Surg Am 84-A(2):208-215
  11. Scolaro JA, Voleti P, Makani A, Namdari S, Mirza A, Mehta S (2014) Surgical fixation of extra-articular distal humerus fractures with a posterolateral plate through a triceps-reflecting technique. J Shoulder Elbow Surg 23(2):251-257
  12. Capo JT, Debkowska MP, Liporace F, Beutel BG, Melamed E (2014) Outcomes of distal humerus diaphyseal injuries fixed with a single-column anatomic plate. Int Orthop 38(5):1037-1043
  13. Jawa A (2010) Treatment of distal diaphyseal humerus fractures. J Hand Surg Am. 35(2):301-302
  14. Meloy GM, Mormino MA, Siska PA, Tarkin IS (2013) A paradigm shift in the surgical reconstruction of extra-articular distal humeral fractures: single-column plating. Injury 44(11):1620-1624
  15. Zimmerman MC, Waite AM, Deehan M, Tovey J, Oppenheim W (1994) A biomechanical analysis of four humeral fracture fixation systems. J Orthop Trauma 8(3):233-239
  16. Tejwani NC, Murthy A, Park J, McLaurin TM, Egol KA, Kummer FJ (2009) Fixation of extra-articular distal humerus fractures using one locking plate versus two reconstruction plates: a laboratory study. J Trauma 66(3):795-799
  17. Thomas PR, Richard EB, Christopher GM (2007) AO philosophy and evolution. In: Thomas PR, Richard EB, Christopher GM (eds) AO principles of fracture management, 2nd edn. Thieme, Stuttgart, pp 1-9
  18. Yang Qing, Wang Fang, Wang Qiugen, Gao Wei, Huang Jianhua, Xiaofeng Wu et al (2012) Surgical treatment of adult extraarticular distal humeral diaphyseal fractures using an oblique metaphyseal locking compression plate via a posterior approach. Med Princ Pract 21:40-45
  19. Chen RC, Harris DJ, Leduc S, Borrelli JJ Jr, Tornetta P III, Ricci WM (2010) Is ulnar nerve transposition beneficial during open reduction and internal fixation of distal humerus fractures? J Orthop Trauma 24(7):391-394
  20. Levy JC, Kalandiak SP, Hutson JJ, Zych G (2005) An alternative method of osteosynthesis for distal humeral shaft fractures. J Orthop Trauma 19(1):43-47
  21. Liporace FA, Gupta S, Jeong GK, Stracher M, Kummer F, Egol KA et al (2005) A biomechanical comparison of a dorsal 3.5-mm T-plate and a volar fixed-angle plate in a model of dorsally unstable distal radius fractures. J Orthop Trauma 19(3):187-191
  22. Stoffel K, Booth G, Rohrl SM, Kuster M (2007) A comparison of conventional versus locking plates in intraarticular calcaneus fractures: a biomechanical study in human cadavers. Clin Biomech (Bristol, Avon) 22:100-105
  23. Weinstein DM, Bratton DR, Ciccone WJ 2nd, Elias JJ (2006) Locking plates improve torsional resistance in the stabilization of three-part proximal humeral fractures. J Shoulder Elbow Surg 15:239-243
  24. Ratcliff JR, Werner FW, Green JK, Harley BJ (2007) Medial buttress versus lateral locked plating in a cadaver medial tibial plateau fracture model. J Orthop Trauma 21:444-448
  25. Higgins TF, Pittman G, Hines J, Bachus KN (2007) Biomechanical analysis of distal femur fracture fixation: fixed-angle screw-plate construct versus condylar blade plate. J Orthop Trauma 21:43-46
  26. Gösling T, Schandelmaier P, Marti A, Hufner T, Partenheimer A, Krettek C (2004) Less invasive stabilization of complex tibial plateau fractures: a biomechanical evaluation of a unilateral locked screw plate and double plating. J Orthop Trauma 18(8):546-551
  27. Mueller KL, Karunakar MA, Frankenburg EP, Scott DS (2003) Bicondylar tibial plateau fractures: a biomechanical study. Clin Orthop Relat Res 412:189-195
  28. Egol KA, Su E, Tejwani NC, Sims SH, Kummer FJ, Koval KJ (2004) Treatment of complex tibial plateau fractures using the less invasive stabilization system plate: clinical experience and a laboratory comparison with double plating. J Trauma 57(2):340-346
  29. Shawn WO (2000) Driscoll: the tricep reflecting anconeus pedicle (TRAP) approach for distal humerus fractures and nonunions. Orthop Clin North Am 31(1):91-101
  30. Bryan RS, Morrey BF (1982) Extensive posterior exposure of the elbow: a triceps-sparing approach. Clin Orthop 166:188-192
  31. Lewicky YM, Sheppard JE, Ruth JT (2007) The combined olecranon osteotomy, lateral paratricipital sparing, deltoid insertion splitting approach for concomitant distal intra-articular and humeral shaft fractures. J Orthop Trauma 21(2):133-139
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.