Introduction

There is no “gold standard” for the type of plate to be used for distal extra-articular humeral fractures; the most used is plating of each column. The objective was to evaluate the short-term clinical and radiological results of a Y- anatomical and innovative locking plate (YALP).

Hypothesis

The hypothesis is: this anatomical and innovative locking plate will produce satisfactory and reliable results on extra-articular distal humerus fracture superior to double plate fixation.

Materials and methods

In a retrospective observational multicenter study, all patients with a distal humerus fracture type 13 A2.2 according to AO classification fixed with a new Y-plate (YALP) were compared to the results of double plate fixation for the same type of fracture. With a follow-up of more than 12 months, the objective and subjective clinical elbow criteria as well as the overall function of the upper limb and radiological assessment were collected.

Results

With an average follow up of 24 ± 11 months, 26 patients met the inclusion criteria and received a YALP and 24 patients received double plate. All patients whose fracture had healed except one were pain-free (mean VAS 0.3 ± 0.6). All patients had good subjective results (mean SEV 96% ± 4). Elbow function was excellent (mean total MEPS 96 ± 4) with normal triceps strength (23/24 patients had a triceps strength graded 5/5 and one patient 4/5) and range of motion (flexion 139 ± 8, extension −7 ± 8 and pronosupination greater than 155 degrees). The operating time was shorter in the YALP group (84 ± 23 minutes versus 97 ± 28 minutes, p = 0.03). The double plate group had more complications; the overall complication rate was significantly higher (p = 0.02) in the double 90-degree plate group (12/24, 50%) with four nonunions, four symptomatic ulnar nerves, three hardware removals for pain and one radial nerve injury versus 5/26 complications (19%, p = 0.02) in the Y-plate group: one iliac graft for nonunion, 1 plate removal due to functional discomfort, 1 twisted YALP, 1 broke interfragmentary screw and one symptomatic ulnar nerve. DASH, SEV, MEPS scores and flexion-extension range were better in the YALP group.

Discussion

YALP produces satisfactory results in supracondylar fractures of the distal humerus. The results of YALP appear to be better than the results with two 90° plates for the same fracture type with a shorter operative time and easier management of fractures with proximal diaphyseal extension.

Level of evidence

III; case control study.

中文翻译：

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Y 形解剖创新锁定钢板与双钢板治疗肱骨髁上骨折的比较研究

介绍

对于用于远端肱骨关节外骨折的钢板类型，没有“金标准”；最常用的是每列的电镀。目的是评估 Y 解剖创新型锁定钢板 (YALP) 的短期临床和放射学结果。

假设

假设是：这种解剖学和创新的锁定钢板将在肱骨远端关节外骨折方面产生优于双钢板固定的满意且可靠的结果。

材料和方法

在一项回顾性观察性多中心研究中，将所有采用新 Y 形钢板 (YALP) 固定的 13 A2.2 型肱骨远端骨折患者与同类型骨折的双钢板固定结果进行了比较。经过12个月以上的随访，收集客观和主观的临床肘关节标准以及上肢的整体功能和放射学评估。

结果

平均随访时间为 24  ±  11 个月，26 名患者符合纳入标准并接受了 YALP，24 名患者接受了双板治疗。除一名患者外，所有骨折均已愈合的患者均无疼痛（平均 VAS 0.3  ±  0.6）。所有患者均具有良好的主观结果（平均 SEV 96%  ± 4）。肘部功能良好（平均总 MEPS 96 ± 4），三头肌力量正常（23/24 名患者的三头肌力量分级为 5/5，一名患者为 4/5）和运动范围（屈曲 139 ± 8，伸展 −7 ± 8 且旋后角度大于 155 度）。YALP 组的手术时间较短（84 ± 23分钟与 97 ± 28分钟，p = 0.03）。双板组并发症较多；双 90 度钢板组 (12/24, 50%) 的总体并发症发生率显着较高 ( p = 0.02)，包括 4 例骨不连、4 例有症状的尺神经、3 例因疼痛而切除的硬件和 1 例桡神经损伤，而 5/ Y 钢板组有 26 例并发症（19%，p = 0.02）：1 例髂骨移植物不愈合，1 例因功能不适而移除钢板，1 例 YALP 扭曲，1 例骨折段间螺钉断裂，1 例有症状的尺神经。YALP 组的 DASH、SEV、MEPS 评分和屈伸范围更好。               

讨论

YALP 在肱骨远端髁上骨折治疗中取得了令人满意的效果。对于相同的骨折类型，YALP 的结果似乎比使用两个 90° 钢板的结果更好，手术时间更短，并且更容易通过近端骨干延伸来处理骨折。

证据级别

三、病例对照研究。