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RÉSUMÉ
Introduction. L'ostéosynthèse est une technique chirurgicale utilisée pour stabiliser et réparer les fractures osseuses à l'aide de dispositifs tels que des plaques, des vis, des clous ou des broches. L’objectif de notre étude était d’évaluer les résultats thérapeutiques et évolutifs du traitement par ostéosynthèse des fractures de la palette humérale chez l’adulte. Méthodologie. Il s’agissait d’une étude rétrospective et transversale conduite du 1er mai 2018 au 30 avril 2023 au service de Traumatologie-Orthopédie du CHU de Brazzaville portant sur tout patient opéré d’une fracture de la palette humérale, âgés de plus de 17 ans et suivis pendant au moins six mois. Le Mayo Elbow Performance Score (MEPS) a été utilisé pour l’évaluation de la récupération fonctionnelle. Résultats. Nous avons étudié 37 dossiers de patients pour un sex ratio de 2,9. L’âge moyen était de 36,41 ans. Le secteur fonctionnel médian de mobilité était de 115° (extrêmes de 75° à 140°). La flexion médiane était de 120° (extrêmes de 100° à 140°) et le déficit d’extension était de 25° (extrêmes de 0° à 45°). Un secteur fonctionnel utile a été obtenu chez 32 patients (86,48 %). La consolidation osseuse a été obtenue chez tous les patients après un délai moyen de 4,47 mois (extrêmes de 3 à 9 mois). Elle était anatomique dans 31 cas (83,78 %) et vicieuse dans six cas (16,22 %). Les complications du traitement étaient les ossifications périarticulaires dans quatre cas (10,81 %) et l’infection du site opératoire dans un cas (2,7 %). Conclusion. L’ostéosynthèse continue d'être une technique chirurgicale efficace pour stabiliser et réparer les fractures de la palette humérale chez les adultes avec une bonne récupération fonctionnelle et à une consolidation osseuse satisfaisante.
ABSTRACT
Introduction. Osteosynthesis is a surgical technique used to stabilize and repair bone fractures using devices such as plates, screws, nails, or pins. The aim of our study was to evaluate the therapeutic and evolutionary outcomes of osteosynthesis treatment for distal humeral fractures in adults. Methodology. This was a retrospective and cross-sectional study conducted from May 1, 2018, to April 30, 2023, at the Orthopedics and Traumatology Department of the Brazzaville University Hospital, including all patients over the age of 17 who had undergone surgery for a distal humeral fractures and were followed up for at least six months. The Mayo Elbow Performance Score (MEPS) was used to assess functional recovery. Results. The median range of motion was 115° (range 75° to 140°). Median flexion was 120° (range 100° to 140°) and extension deficit was 25° (range 0° to 45°). A useful functional range was achieved in 32 patients (86.48%). Bone healing was achieved in all patients after an average time of 4.47 months (range 3 to 9 months). Healing was anatomical in 31 cases (83.78%) and malunion in six cases (16.22%). Treatment complications included periarticular ossifications in four cases (10.81%) and surgical site infection in one case (2.7%). Conclusion. Osteosynthesis yielded favorable functional and radiological outcomes in our series. The quality of the results mainly depends on the timing of the operation and the proper execution of the surgical procedure.
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References
- Robinson CM, Hill RMF, Jacobs N, Dall G, Court-Brown CM. Adult Distal Humeral Metaphyseal Fractures: Epidemiology and Results of Treatment: Journal of Orthopaedic Trauma 2003;17(1):38‑47.
- Nauth A, McKee MD, Ristevski B, Hall J, Schemitsch EH. Distal Humeral Fractures in Adults. Journal of Bone and Joint Surgery 2011;93(7):686‑700.
- Cadot B, Da Silva Rosa R, Tawil HJ. Fractures de l’extrémité inférieure de l’humérus : techniques chirurgicales. EMC - Techniques chirurgicales - Orthopédie – Traumatologie 2006;1(1):1‑11.
- Saragaglia D, Rouchy RC, Mercier N. Fractures de l’humérus distal ostéosynthésées par plaque Lambda® : à propos de 75 cas au recul moyen de 9,5 ans. Revue de Chirurgie Orthopédique et Traumatologique 2013;99(6):586‑92.
- Diederichs G, Issever AS, Greiner S, Linke B, Korner J. Three-dimensional distribution of trabecular bone density and cortical thickness in the distal humerus. Journal of Shoulder and Elbow Surgery. mai 2009;18(3):399‑407.
- Ducrot G, Bonnomet F, Adam P, Ehlinger M. Traitement des fractures de l’humérus distal par plaque verrouillée LCP DHP™ chez les sujets de plus de 65ans. Revue de Chirurgie Orthopédique et Traumatologique 2013;99(2):112‑21.
- Helfet DL, Schmeling GJ. Bicondylar intraarticular fractures of the distal humerus in adults. Clin Orthop Relat Res 1993;292:26‑36.
- Cognet JM, Dujardin C, Bonnomet F, Simon P. Evaluation d’un nouveau type d’ostéosynthèse : le concept LCP. Rev Chir Orthop 2002;88:291.
- Meinberg E, Agel J, Roberts C, Karam M, Kellam J. Fracture and Dislocation Classification Compendium—2018. Journal of Orthopaedic Trauma. janv 2018;32(1):S1‑10.
- Cauchoix J, Duparc J, Boulez P. [Treatment of open fractures of the leg]. Paris; Mem Acad Chir 1957;83(25‑26):811‑22.
- Morrey BF, Askew LJ, Chao EY. A biomechanical study of normal functional elbow motion. J Bone Joint Surg 1981;63(6):872-7.
- Morrey BF, An KN. Functional evaluation of the elbow. In: Morrey BF, editor. The elbow and its disorders. 2nd ed. Philadelphia, PA: WB Saunders; 1993. p. 86—9.
- Robinson CM, Hill RM, Jacobs N, Dall G, Court-Brown CM. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma 2003;17:38-47.
- John H, Rosso R, Neff U, Bodoky A, Regazzoni P, Harder F. Operative treatment of distal humeral fractures in the elderly. J Bone Joint Surg Br 1994;76(5):793-6.
- Holdsworth BJ, Mossad MM. Fractures of the adult distal humerus. Elbow function after internal fixation. J Bone Joint Surg Br 1990;72:362-5.
- O’Driscoll SW. Optimizing stability in distal humeral fracture fixation. J Shoulder Elbow Surg 2005; 14(1 Suppl S):186S-194S.
- Huang TL, Chiu FY, Chuang TY, Chen TH. The results of open reduction and internal fixation in elderly patients with severe fractures of the distal humerus: a critical analysis of the results. J Trauma 2005; 58(1):62-9.
- Soon JL, Chan BK, Low CO. Surgical fixation of intra-articular fractures of the distal humerus in adults. Injury2004; 35(1):44-54.
- Coles CP, Barei DP, Nork SE, Taitsman LA, Hanel DP, Bradford Henley M. The olecranon osteotomy: a six-year experience inthe treatment of intra-articular fractures of the distal humerus. J Orthop Trauma 2006; 20(3):164-71.
- Garcia JA, Mykula R, Stanley D. Complex fractures of the distal humerus in the elderly: the role of total elbow replacement as primary treatment. J Bone Joint Surg 2002; 84(6):812-6.
- Chalidis B, Dimitriou C, Papadopoulos P, Petsatodis G, Giannoudis PV. Total elbow arthroplasty for the treatment of insufficient distal humerus fractures. A retrospective clinical study and review of literature. Injury Int J Care Injured 2009; 40(6):582-90.
- Edwards TB. Editorial. Journal of Shoulder and Elbow Surgery. mars 2011;20(2):S1.
- Ennis O, Miller D, Kelly CP. Fractures of the adult elbow. Current Orthopaedics 2008;22(2):111‑31.
- Chantelot C, Wavreille G. Fracture de la palette humérale de l’adulte. EMC - Appareil locomoteur 2006;1(3):1‑12.
- Theivendran K, Duggan PJ, Deshmukh SC. Surgical treatment of complex distal humeral fractures: functional outcome after internal fixation using precontoured anatomic plates. J Shoulder Elbow Surg 2010; 19(4):524-32.
- Greiner S, Haas NP, Bail HJ. Outcome after open reduction and angular stable internal fixation for supra-intercondylar fractures of the distal humerus: preliminary results with the LCP distal humerus system. Arch Orthop Trauma Surg2008; 128(7):723-9.
- Pajarinen J, Björkenheim JM. Operative treatment of type C intercondylar fractures of the distal humerus: results after a mean follow-up of 2 years in a series of 18 patients. J Shoulder Elbow Surg 2002; 11(1):48-52.
- Kaiser T, Brunner A, Hohendorff B, Ulmar B, Babst R. Treatment of supra and intra-articular fractures of the distal humerus with LCP Distal Humerus Plate. A 2-year follow-up. J Shoulder Elbow Surg 2011; 20(2):206-12.
- Lecestre P, Aubaniac JM, Claisse P, et al. Les fractures de l’extrémité inférieure de l’humérus chez l’adulte - Table ronde. Rev Chir Orthop 1980;66:21-50.
- Gofton WT, MacDermid JC, Patterson SD, Faber KJ, King GJ. Functional outcome of AO type C distal humeral fractures. J Hand Surg 2003; 28(2):294-308.
- Chen G, Liao Q, Luo W, Li K, Zhao Y, Zhong D. Triceps-sparing versus olecranon osteotomy for ORIF. Analysis of 67 cases of intercondylar fractures of the distal humerus. Injury Int J Care Injured 2011; 42(4):366-70.
References
Robinson CM, Hill RMF, Jacobs N, Dall G, Court-Brown CM. Adult Distal Humeral Metaphyseal Fractures: Epidemiology and Results of Treatment: Journal of Orthopaedic Trauma 2003;17(1):38‑47.
Nauth A, McKee MD, Ristevski B, Hall J, Schemitsch EH. Distal Humeral Fractures in Adults. Journal of Bone and Joint Surgery 2011;93(7):686‑700.
Cadot B, Da Silva Rosa R, Tawil HJ. Fractures de l’extrémité inférieure de l’humérus : techniques chirurgicales. EMC - Techniques chirurgicales - Orthopédie – Traumatologie 2006;1(1):1‑11.
Saragaglia D, Rouchy RC, Mercier N. Fractures de l’humérus distal ostéosynthésées par plaque Lambda® : à propos de 75 cas au recul moyen de 9,5 ans. Revue de Chirurgie Orthopédique et Traumatologique 2013;99(6):586‑92.
Diederichs G, Issever AS, Greiner S, Linke B, Korner J. Three-dimensional distribution of trabecular bone density and cortical thickness in the distal humerus. Journal of Shoulder and Elbow Surgery. mai 2009;18(3):399‑407.
Ducrot G, Bonnomet F, Adam P, Ehlinger M. Traitement des fractures de l’humérus distal par plaque verrouillée LCP DHP™ chez les sujets de plus de 65ans. Revue de Chirurgie Orthopédique et Traumatologique 2013;99(2):112‑21.
Helfet DL, Schmeling GJ. Bicondylar intraarticular fractures of the distal humerus in adults. Clin Orthop Relat Res 1993;292:26‑36.
Cognet JM, Dujardin C, Bonnomet F, Simon P. Evaluation d’un nouveau type d’ostéosynthèse : le concept LCP. Rev Chir Orthop 2002;88:291.
Meinberg E, Agel J, Roberts C, Karam M, Kellam J. Fracture and Dislocation Classification Compendium—2018. Journal of Orthopaedic Trauma. janv 2018;32(1):S1‑10.
Cauchoix J, Duparc J, Boulez P. [Treatment of open fractures of the leg]. Paris; Mem Acad Chir 1957;83(25‑26):811‑22.
Morrey BF, Askew LJ, Chao EY. A biomechanical study of normal functional elbow motion. J Bone Joint Surg 1981;63(6):872-7.
Morrey BF, An KN. Functional evaluation of the elbow. In: Morrey BF, editor. The elbow and its disorders. 2nd ed. Philadelphia, PA: WB Saunders; 1993. p. 86—9.
Robinson CM, Hill RM, Jacobs N, Dall G, Court-Brown CM. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma 2003;17:38-47.
John H, Rosso R, Neff U, Bodoky A, Regazzoni P, Harder F. Operative treatment of distal humeral fractures in the elderly. J Bone Joint Surg Br 1994;76(5):793-6.
Holdsworth BJ, Mossad MM. Fractures of the adult distal humerus. Elbow function after internal fixation. J Bone Joint Surg Br 1990;72:362-5.
O’Driscoll SW. Optimizing stability in distal humeral fracture fixation. J Shoulder Elbow Surg 2005; 14(1 Suppl S):186S-194S.
Huang TL, Chiu FY, Chuang TY, Chen TH. The results of open reduction and internal fixation in elderly patients with severe fractures of the distal humerus: a critical analysis of the results. J Trauma 2005; 58(1):62-9.
Soon JL, Chan BK, Low CO. Surgical fixation of intra-articular fractures of the distal humerus in adults. Injury2004; 35(1):44-54.
Coles CP, Barei DP, Nork SE, Taitsman LA, Hanel DP, Bradford Henley M. The olecranon osteotomy: a six-year experience inthe treatment of intra-articular fractures of the distal humerus. J Orthop Trauma 2006; 20(3):164-71.
Garcia JA, Mykula R, Stanley D. Complex fractures of the distal humerus in the elderly: the role of total elbow replacement as primary treatment. J Bone Joint Surg 2002; 84(6):812-6.
Chalidis B, Dimitriou C, Papadopoulos P, Petsatodis G, Giannoudis PV. Total elbow arthroplasty for the treatment of insufficient distal humerus fractures. A retrospective clinical study and review of literature. Injury Int J Care Injured 2009; 40(6):582-90.
Edwards TB. Editorial. Journal of Shoulder and Elbow Surgery. mars 2011;20(2):S1.
Ennis O, Miller D, Kelly CP. Fractures of the adult elbow. Current Orthopaedics 2008;22(2):111‑31.
Chantelot C, Wavreille G. Fracture de la palette humérale de l’adulte. EMC - Appareil locomoteur 2006;1(3):1‑12.
Theivendran K, Duggan PJ, Deshmukh SC. Surgical treatment of complex distal humeral fractures: functional outcome after internal fixation using precontoured anatomic plates. J Shoulder Elbow Surg 2010; 19(4):524-32.
Greiner S, Haas NP, Bail HJ. Outcome after open reduction and angular stable internal fixation for supra-intercondylar fractures of the distal humerus: preliminary results with the LCP distal humerus system. Arch Orthop Trauma Surg2008; 128(7):723-9.
Pajarinen J, Björkenheim JM. Operative treatment of type C intercondylar fractures of the distal humerus: results after a mean follow-up of 2 years in a series of 18 patients. J Shoulder Elbow Surg 2002; 11(1):48-52.
Kaiser T, Brunner A, Hohendorff B, Ulmar B, Babst R. Treatment of supra and intra-articular fractures of the distal humerus with LCP Distal Humerus Plate. A 2-year follow-up. J Shoulder Elbow Surg 2011; 20(2):206-12.
Lecestre P, Aubaniac JM, Claisse P, et al. Les fractures de l’extrémité inférieure de l’humérus chez l’adulte - Table ronde. Rev Chir Orthop 1980;66:21-50.
Gofton WT, MacDermid JC, Patterson SD, Faber KJ, King GJ. Functional outcome of AO type C distal humeral fractures. J Hand Surg 2003; 28(2):294-308.
Chen G, Liao Q, Luo W, Li K, Zhao Y, Zhong D. Triceps-sparing versus olecranon osteotomy for ORIF. Analysis of 67 cases of intercondylar fractures of the distal humerus. Injury Int J Care Injured 2011; 42(4):366-70.