Conservative treatment in displaced fractures of the humeral capitellum: a reduction technique under local anaesthesia.

We report the case of a 46-year-old woman who struck her right elbow on the ground after a fall on ice. Radiography showed a right humeral capitellar fracture, and CT further confirmed a Dubberley type 1A fracture. Closed reduction was performed under local anaesthesia, and an anatomical position was obtained. After the reduction, her right elbow was casted for 18 days. Three months after the injury, bone union was achieved without displacement, and the active range of motion of her right elbow recovered similar to the unaffected side. At 1 year postinjury, the Grantham score was excellent, and she obtained a two-point score on the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. Although surgical treatment is recommended for a displaced humeral capitellar fracture, a Dubberley type 1A (no posterior column fracture of a distal humerus) can be effectively treated by early closed reduction.

Tratamiento de la pseudoartrosis séptica y recalcitrante de la diáfisis humeral mediante impactación intramedular / Treatment of the septic and recalcitrant humeral shaft nounion by means intramedullary impactation

Se presenta un caso de una fractura de la diáfisis humeral complicada con una pseudoartrosis recalcitrante, infección y parálisis radial. Se propone una alternativa de tratamiento que, por su sencillez y aplicabilidad, puede incluirse en el arsenal terapéutico para solucionar esta grave patología (AU)

We present a case of humeral shaft fracture complicated with recalcitrant nonunion, infection and radial nerve paralisys. A treatment alternative sets out that, by its simplicity and applicability, deserves to have it in account within the therapeutic arsenal which we arrange to the solution of this serious pathology (AU)

[Manual reduction of 90 degree bending elbow and external fixation with paper splint for treatment of type I capitellum fractures].

OBJECTIVE: To study the operation points of manual reduction for treatment of capitellum fractures of type I and analyze the characteristics of fixation with paper splint. METHODS: From April 2000 to February 2008, 27 cases with capitellum fractures of type I were treated by manual reduction of 90 degrees bending elbow and external fixation with paper splint, included 23 males and 4 females aged from 5 to 14 years old (means 8.9 years) with the course from 1 to 23 hours (averaged 5.4 hours). Before treatment all the wounded elbows were swollen and malfunctioned, the X-ray film showed that the fracture fragments of capitellum were separated and upside down displaced in varying degrees. During reduction, the correct restoration point was found and the reduction was correct, continuous and steady, and coordinated the passive movement of forearm and elbow joint, and the 90 degrees bending elbow was fixed by paper splint. All the patients were assessed according to JOA elbow joint function assessment method. RESULTS: All 27 patients were followed-up for from 6 months to 2 years (averaged 17 months). All the elbow joints were painless, the movement and functions were normal, the elbow joints were stable. After reduction, no complication was found. There were 25 cases with the fracture site reaches or nearly reaches healing of anatomical counterparts, only 2 cases with slight cubitus valgus deformity. According to JOA score 25 cases gained 100 scores and 2 cases gained 97 scores. CONCLUSION: This method has advantage of strong stability, high success rate, firm and easy fixation, without pressure sore and necrosis.

A biomechanical evaluation of methods of distal humerus fracture fixation using locking compression plates versus conventional reconstruction plates.

OBJECTIVES: To examine the biomechanical behavior of 2 techniques of double-plate osteosynthesis for fractures of the adult distal humerus using conventional reconstruction plates and locking compression plates. DESIGN: Basic science study. SETTING: Experimental in vitro study. PATIENTS/PARTICIPANTS: Forty fresh-frozen human distal humeri specimens. INTERVENTION: Four matched groups with 10 humeri each, median age 74 years (46-95), were created using similar bone mineral density values. Two standard configurations of double-plate osteosynthesis (dorsal or 90 degrees configuration) with either conventional reconstruction plates or locking compression plates were studied for biomechanical properties of the constructs. A fracture model with a 5-mm supracondylar osteotomy gap simulating metaphyseal comminution (AO type 13-A3.3) was used. MAIN OUTCOME MEASUREMENT: Stiffness testing of the constructs in anterior/posterior bending, torsion, and axial compression loading. Evaluation of alterations of the bone-implant interface and failure patterns under cyclic loading and strength testing. RESULTS: The study demonstrates that primary stiffness in anterior/posterior bending and torsional loading is significantly increased by using locking compression plates in a 90 degrees configuration (P < 0.05) as compared with dorsally applied plates. The differences between the different plate types are insignificant if applied in the same configuration. It is demonstrated that none of the tested implants failed under cyclic loading within the number of cycles expected for 3 months of use. The bone-implant interface is less likely to fail during strength testing with locking compression plates. CONCLUSION: The biomechanical behavior of the osteosynthesis depends more on plate configuration than plate type. Advantages of locking compression plates are only significant if compared with dorsal plate application techniques. Nevertheless, locking compression plates are helpful supplementary tools for achieving primary stable fracture fixation. This might be of considerable clinical relevance in patients with diminished bone mineral quality or in the presence of metaphyseal comminution.