원위 상완골 분쇄 골절의 수술적 치료 결과

The Results of Surgical Treatment of Comminuted Fractures of Distal humerus

Purpose: To report the results of surgical treatment of comminuted fractures of distal humerus and to identify factors that affect the results. Materials and Methods: Thirty-two patients who were treated with open reduction and internal fixation for comminuted fracture of distal humerus were enrolled. According to the AO classification, A2.3 was 1 case, A3.2, 2 cases, A3.3, 8 cases, B1.3, 1 case, B2.3, 1 case, C2.2, 5 cases, C2.3, 4 cases, C3.2, 3 cases and C3.3, 7 cases. As fixation technique, 17 cases were fixed by double plates, 4 cases by only K-wires, 4 cases by only screws, 3 cases by K-wires and screws and 4 cases by one plate and screws. The mean age at the time of the operation was 49 years(range, $19{\sim}77$ years). The mean follow-up period was 16 months(range, $8{\sim}51$ months). Results: At the last follow-up, the mean maximum flexion was $116.4^{\circ}\;(range,\;85{\sim}140^{\circ})$ and the mean loss of terminal extension was $11.8^{\circ}\;(range,\;0{\sim}40^{\circ})$. The average Mayo elbow performance score was $91.4^{\circ}\;(range,\;55{\sim}100^{\circ})$. Overall 29 cases(91%) showed good to excellent results. The mean range of motion of extraarticular and intraarticular fracture group was $105.5^{\circ}\;(range,\;65{\sim}140^{\circ})$ and $104^{\circ}\;(range,\;55{\sim}140^{\circ})$, respectively. The average elbow score of both groups was$93^{\circ}\;(range,\;70{\sim}100^{\circ})$ and $90.7^{\circ}\;(range,\;55{\sim}100^{\circ})$. Over 90% showed more than good results. 30 cases(94%) showed complete bony union but two cases, nonunion. One case of the nonunion cases underwent replating with bone graft as revision surgery and total elbow arthroplasty was performed in the other case. At the last follow-up, 27 patients(84.4%) showed subjective satisfaction. Conclusion: Open reduction and internal fixation with appropriate surgical technique for comminuted fractures of distal humerus showed good results, which were not affected by age at the time of operation, fixation methods and anterior transposition of the ulnar nerve. Transolecranon approach may be considered as good choice for intraarticular comminuted fractures of distal humerus.