Acta Orthopaedica et Traumatologica Turcica
Research Articles

Outcome after the surgical treatment of the Dubberley type B distal humeral capitellar and trochlear fractures with a buttress plate

1.

Clinic of Orthopaedics and Traumatology, İstanbul Medicine Hospital, İstanbul, Turkey

2.

Department of Orthopaedics and Traumatology, Koç University, School of Medicine, İstanbul, Turkey

3.

Clinic of Orthopaedics and Traumatology, Florence Nightingale Hospital, İstanbul, Turkey

AOTT 2020; 54: 364-371
DOI: 10.5152/j.aott.2020.20092
Read: 368 Downloads: 196 Published: 12 June 2020

Objective: This study aimed to evaluate the functional outcomes of the surgical treatment performed with a buttress plate for the trochlear and distal capitellum fractures with posterior extension in the humerus.

Methods: The data belonging to 6 female and 4 male patients with a mean age of 43.8±11.1 (34–72) years were retrospectively evaluated. The mean follow-up period was 59.6±38.79 (22–127) months. The trochlear extension and posterior comminution of the fractures were assessed through the initial X-rays and computerized tomography images. Ten patients were classified as Dubberley type B. All fractures were treated surgically, with open reduction and internal fixation using a lateral buttress plate, headless cannulated screws, and Kirschner (K)-wires. The passive flexion and extension exercises were initiated at the first postoperative day. The patients were evaluated clinically and radiographically at the final follow-up. The outcomes were quantified using the Mayo Elbow Performance Index (MEPI), visual analog scale (VAS) pain score, and the patient’s opinion.

Results: At the final follow-up, the mean elbow flexion was 137.5°±3° (132°–140°), extension was −17.9°±9.2° (10°–35°), pronation was 72.2°±2.6° (68°–75°), and supination was 78.9°±4.09 (72°–85°). The mean MEPI score was calculated as 95.5±5.98 (85–100). According to the MEPI score, 8 patients were evaluated as excellent and 2 as good. The mean VAS pain score was 0.8±1.03 (0–2). The subjective patient evaluation was recorded as excellent in 5 patients, good in 3 patients, and moderate in 2 patients. One patient developed avascular necrosis and 2 patients had elbow joint arthrosis. K-wire migration was observed in one patient. Loss of reduction, nonunion, malunion, reflex sympathetic dystrophy, or heterotopic ossification were not encountered.

Conclusion: The management of distal humeral fractures is challenging, and favorable outcomes are closely associated with early joint motion. A solid fixation grants early mobilization. An internal fixation using lateral buttress plate, headless cannulated screws, and interfragmentary K-wires provides a solid and secure construction that allows early postoperative joint motion.

Level of Evidence: Level IV, Therapeutic study

Cite this article as: Demir MT, Ertan Birsel S, Salih M, Pirinçci Y, Birsel O, Kesmezacar H. Outcome after the surgical treatment of the Dubberley type B distal humeral capitellar and trochlear fractures with a buttress plate. Acta Orthop Traumatol Turc 2020; 54(4): 364-71.

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ISSN1017-995X EISSN 2589-1294