Precontoured anatomical plate fixation is not superior to recon plate fixation for intercondylar fracture humerus in adults

Abstract

Abstract Introduction: Intercondylar fractures are intraarticular distal humerus fractures that are frequently linked to osteopenia, comminution, and displacement. Due to its intricate anatomy, fractured bone frequently consists of many fragments and has few fixing possibilities. Open reduction and internal fixation (ORIF) is the best treatment option for these fractures, most commonly either with precontoured anatomical locking plates or recon plates. This study aims to compare the functional and radiological outcomes and rate of complications in the management of intercondylar fracture of the humerus with recon plates and precontoured anatomical plates. Materials and Methods: We have prospectively evaluated the outcome of precontoured anatomical plate vs recon plate fixation in the management of adult intercondylar fracture of the humerus in 20 patients having 10 patients in each of the groups. The study was done between November 2020 and November 2022. The recon plate group was designated as group 1 and the precontoured anatomic plate group as group 2. Orthogonal plate fixation was done in both groups. Ulnar nerve transposition was not done in any case. The study included seven patients of AO13C1, eight patients of AO13C2, and five patients of AO13C3 type of intercondylar fracture of the humerus. The mean follow-up period was 8.4 months. The functional outcome was assessed by the Mayo Elbow Performance Scoring (MEPS) system and the radiological outcome was by elbow anteroposterior/lateral radiographs. The minimum follow-up duration was 6 months. Results: In both groups, the average duration of operation and hospitalization was comparable. At 3 months follow-up after surgery, the mean MEPS in the locking precontoured anatomical plate group (group 2 = 82) was significantly higher than that of the traditional recon plate (group 1 = 69.50; P = 0.026). However, the mean MEPS was comparable in both the study groups (group 1 = 81.50, group 2 = 88, P = 0.154) at 6 months after the surgery. Range of motion (ROM) was comparable for each study group after 3 months and final follow-up as well. The patients in group 2 took much less time to achieve union than the patients in group 1 (P = 0.001); however, in total 95% of the study patients achieved union. The rate of complications including wound infection, tension band wire backout, implant loosening, and joint stiffness was similar in both groups. Conclusion: Precontoured anatomical plates and recon plates did not significantly differ in the functional results of distal humeral fractures (AO type 13C), including the ROM and MEPS at a mean follow-up duration of 8.4 months; however, there was a considerable variance in the union time, in which patients operated with precontoured anatomical plates showed much less time to achieve union than the recon plates.