• R Elhage, C Maynou, P M Jugnet, and H Mestdagh.
• Service d'orthopédie A, hôpital Roger Salengro, CHRU Lille, 2, avenue Oscar Lambret, 59037 Lille, France.
• Chir Main. 2001 Apr 1; 20 (2): 144-54.

Purpose Of The StudyIn intra-articular fractures of the distal humerus, full functional recovery is difficult to obtain. An osteosynthesis by plate is the treatment of choice, but location and type of plate always remain open for debate. We present a consecutive series of intra-articular fractures of the distal humerus treated by osteosynthesis. The aim of the study is to determine and to compare the results of various types of osteosynthesis.Materials And MethodsWe reviewed 55 patients at an average of 108 months after early internal fixation for intraarticular displaced fractures of the distal humerus type C according to the A.O. classification. Intraarticular osteotomy of olecranon was used in 37 subjects (67.27%). The osteosynthesis has been achieved with a precasted lateral plate for 31 patients, with two posterior plates in 18 subjects, with a screwing on triangulation in four patients and with pins in two patients.ResultsThe osteosynthesis with two posterior plates obtained a good result between 78.57% and 92.86% of cases, whereas the osteosynthesis with a precasted lateral plate gave a good result between 73.68% and 76.32% of cases according to the score used for estimation. In the aggregate, the functional estimate has a good result in the most of the cases whatever the score of estimate. At follow up we observed an average range of motion of 103 degrees. This value is quite good because it corresponds to the sector of the useful functional mobility.DiscussionThe review of our cases and the literature prompt us to follow the way of the osteosynthesis in adjusting indications to the type of fracture and in using a well-codifed technology. As it is already the case, a minimal osteosynthesis by screwing or by pins must be left except for peculiar cases in osteopenic elderly patients and if they have a very poor health. Contrary to other studies, the osteosynthesis with two posterior plates has given us better results provided that it has been systematically associated with a triangulation screwing in order to increase the strength of fitting in the sagittal plan. The precasted lateral plate gives a stable fitting too, nevertheless it is well advised to associate it to an osteosynthesis of medium column especially when the fracture is type C3. We have statistically proved that the age is not contraindication for osteosynthesis.ConclusionThis surgery is difficult and entails complications. The dismantling of the synthesis always gives poor results particularly if it is succeeded by an immobilization in plaster. The poor reduction, origin of arthrosis, of loss of bony substance and of calcifications worsen the functional prognosis. Last but not least, a good result can be obtained in the most of the cases however the types of fractures.

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