Treatment of distal humerus fracture with unexposed ulnar nerve medial elbow incision and anatomical locking compression plate_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Tenglong ¹ , XU Tao ¹ , LIANG Hong ¹ , LAN Lin ¹ , LUO Qiang ¹ , LI Dapeng ¹ , YAN Chun ¹ , LIU Anxiong ¹ ,  YUAN Yi ²

1. Department of Orthopaedics, Pingshan Traditional Chinese Medicine Hospital, Pingshan Sichuan, 645350, P.R.China;
2. Department of Orthopaedics, Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;

Corresponding?author：

YUAN Yi, Email: 270483309@qq.com

Keywords：

Ulnar nerve; distal humerus fracture; locking compression plate; internal fixation

DOI：

10.7507/1002-1892.201808077

Video：

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Objective To investigate the feasibility and effectiveness of unexposed ulnar nerve medial elbow incision, open reduction and internal fixation of anatomical locking compression plate (LCP) for distal humerus fractures.Methods Fourteen patients with distal humerus fracture were treated between January 2014 and June 2017. There were 5 males and 9 females, aged 18-85 years (mean, 65.5 years). The causes of injury included falling from height in 12 cases and traffic accident in 2 cases, all were closed fractures. Fractures were classified according to the AO/Association for the Study of Internal Fixation (AO/ASIF): 3 cases of type A2, 2 cases of type A3, 4 cases of type B2, 2 cases of type C1, 2 cases of type C2, and 1 case of type C3; without ulnar nerve damage. The time from injury to operation was 4-15 days, with an average of 7 days. The type B2 fractures were treated with unexposed ulnar nerve elbow medial incision and anatomic LCP internal fixation, the rest patients were all treated with unexposed ulnar nerve medial plus conventional lateral approach and bilateral LCP internal fixation.Results The operation time was 50-140 minutes (mean, 80 minutes), and the intraoperative blood loss was 20-200 mL (mean, 70 mL). There was no blood vessels or nerve damage during operation. All incisions healed by first intension, and no incision infection occurred. All the 14 cases were followed up 9-24 months (mean, 13 months). X-ray films showed that all fractures healed within 4 months without complications such as nonunion and osteomyelitis. No ulnar nerve injury, cubitus varus deformity, and ossifying myositis occurred during follow-up. At last follow-up, the elbow function was assessed by Mayo Elbow Performance score (MEPS), the results were excellent in 8 cases, good in 4 cases, fair in 1 case, and poor in 1 case (type C3 fracture), with the excellent and good rate of 85.7%.Conclusion The unexposed ulnar nerve medial elbow incision can be used effectively to reduct the fracture, and it is not prone to ulnar nerve injury. Combined with the lateral approach to treat the distal humerus fracture, which has the advantages of short operation time, few trauma, little bleeding, and reliable effectiveness.

Citation： ZHANG Tenglong, XU Tao, LIANG Hong, LAN Lin, LUO Qiang, LI Dapeng, YAN Chun, LIU Anxiong, YUAN Yi. Treatment of distal humerus fracture with unexposed ulnar nerve medial elbow incision and anatomical locking compression plate. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(4): 440-444. doi: 10.7507/1002-1892.201808077 Copy

1.	Beazley JC, Baraza N, Jordan R, et al. Distal humeral fractures-current concepts. Open Orthop J, 2017, 11: 1353-1363.
2.	Zlotolow DA, Catalano LW 3rd, Barron OA, et al. Surgical exposures of the humerus. J Am Acad Orthop Surg, 2006, 14(13): 754-765.
3.	魏力標, 安智全. 肱骨遠端骨折手術治療研究進展. 國際骨科學雜志, 2017, 38(6): 353-356.
4.	Yamaguchi K, Sweet FA, Bindra R, et al. The extraneural and intraneural arterial anatomy of the ulnar nerve at the elbow. J Shoulder Elbow Surg, 1999, 8(1): 17-21.
5.	Ruan HJ, Liu JJ, Fan CY, et al. Incidence, management, and prognosis of early ulnar nerve dysfunction in type C fractures of distal humerus. J Trauma, 2009, 67(6): 1397-1401.
6.	Shearin JW, Chapman TR, Miller A, et al. Ulnar nerve management with distal humerus fracture fixation: a meta-analysis. Hand Clin, 2018, 34(1): 97-103.
7.	McKee MD, Jupiter JB, Bosse G, et al. Outcome of ulnar neurolysis during post-traumatic reconstruction of the elbow. J Bone Joint Surg (Br), 1998, 80(1): 100-105.
8.	余英劍, 穆天旺, 陳偉全, 等. 尺神經肌下前置在C型肱骨遠端骨折治療中的應用. 實用醫學雜志, 2010, 26(11): 1982-1983.
9.	徐杏榮, 馮萬文, 李向東, 等. 經保留伸肘裝置的后側入路手術治療成人肱骨遠端骨折. 中國修復重建外科雜志, 2014, 28(7): 921-922.
10.	張川, 張作君, 昌中孝, 等. 肱三頭肌兩側入路和鷹嘴V形截骨入路治療肱骨遠端 C3型骨折療效比較. 中國修復重建外科雜志, 2018, 32(10): 1321-1325.
11.	Nauth A, McKee MD, Ristevski B, et al. Distal humeral fractures in adults. J Bone Joint Surg (Am), 2011, 93(7): 686-700.
12.	Vazquez O, Rutgers M, Ring DC, et al. Fate of the ulnar nerve after operative fixation of distal humerus fractures. J Orthop Trauma, 2010, 24(7): 395-399.
13.	Chen RC, Harris DJ, Leduc S, et al. Is ulnar nerve transposition beneficial during open reduction internal fixation of distal humerus fractures? J Orthop Trauma, 2010, 24(7): 391-394.
14.	王思群, 吳建國, 夏新雷, 等. 重建鋼板固定和尺神經前置治療肱骨髁間骨折. 中華骨科雜志, 2003, 23(8): 474-478.
15.	吳佳卉. 臂叢神經或全身麻醉雙鈦板內固定治療肱骨遠端C型骨折. 中國實用神經疾病雜志, 2012, 15(3): 67-68.
16.	孟德強, 劉德昌, 張新潮, 等. 肱骨髁間骨折雙鎖定鋼板內固定尺神經前置的臨床效果分析. 創傷外科雜志, 2015, 17(1): 36-38.

1. Beazley JC, Baraza N, Jordan R, et al. Distal humeral fractures-current concepts. Open Orthop J, 2017, 11: 1353-1363.
2. Zlotolow DA, Catalano LW 3rd, Barron OA, et al. Surgical exposures of the humerus. J Am Acad Orthop Surg, 2006, 14(13): 754-765.
3. 魏力標, 安智全. 肱骨遠端骨折手術治療研究進展. 國際骨科學雜志, 2017, 38(6): 353-356.
4. Yamaguchi K, Sweet FA, Bindra R, et al. The extraneural and intraneural arterial anatomy of the ulnar nerve at the elbow. J Shoulder Elbow Surg, 1999, 8(1): 17-21.
5. Ruan HJ, Liu JJ, Fan CY, et al. Incidence, management, and prognosis of early ulnar nerve dysfunction in type C fractures of distal humerus. J Trauma, 2009, 67(6): 1397-1401.
6. Shearin JW, Chapman TR, Miller A, et al. Ulnar nerve management with distal humerus fracture fixation: a meta-analysis. Hand Clin, 2018, 34(1): 97-103.
7. McKee MD, Jupiter JB, Bosse G, et al. Outcome of ulnar neurolysis during post-traumatic reconstruction of the elbow. J Bone Joint Surg (Br), 1998, 80(1): 100-105.
8. 余英劍, 穆天旺, 陳偉全, 等. 尺神經肌下前置在C型肱骨遠端骨折治療中的應用. 實用醫學雜志, 2010, 26(11): 1982-1983.
9. 徐杏榮, 馮萬文, 李向東, 等. 經保留伸肘裝置的后側入路手術治療成人肱骨遠端骨折. 中國修復重建外科雜志, 2014, 28(7): 921-922.
10. 張川, 張作君, 昌中孝, 等. 肱三頭肌兩側入路和鷹嘴V形截骨入路治療肱骨遠端 C3型骨折療效比較. 中國修復重建外科雜志, 2018, 32(10): 1321-1325.
11. Nauth A, McKee MD, Ristevski B, et al. Distal humeral fractures in adults. J Bone Joint Surg (Am), 2011, 93(7): 686-700.
12. Vazquez O, Rutgers M, Ring DC, et al. Fate of the ulnar nerve after operative fixation of distal humerus fractures. J Orthop Trauma, 2010, 24(7): 395-399.
13. Chen RC, Harris DJ, Leduc S, et al. Is ulnar nerve transposition beneficial during open reduction internal fixation of distal humerus fractures? J Orthop Trauma, 2010, 24(7): 391-394.
14. 王思群, 吳建國, 夏新雷, 等. 重建鋼板固定和尺神經前置治療肱骨髁間骨折. 中華骨科雜志, 2003, 23(8): 474-478.
15. 吳佳卉. 臂叢神經或全身麻醉雙鈦板內固定治療肱骨遠端C型骨折. 中國實用神經疾病雜志, 2012, 15(3): 67-68.
16. 孟德強, 劉德昌, 張新潮, 等. 肱骨髁間骨折雙鎖定鋼板內固定尺神經前置的臨床效果分析. 創傷外科雜志, 2015, 17(1): 36-38.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of distal humerus fracture with unexposed ulnar nerve medial elbow incision and anatomical locking compression plate

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