Advertisement
Journal of Shoulder and Elbow Surgery

Complications of articular distal humeral fracture fixation: a systematic review and meta-analysis

Published:March 09, 2021DOI:https://doi.org/10.1016/j.jse.2021.02.017

      Background

      Distal humeral fractures are relatively rare injuries in adults. Fractures that involve the articular surface can be particularly challenging to treat. Open reduction–internal fixation (ORIF) remains the preferred treatment for most intra-articular distal humeral fractures, depending on the degree of comminution and functional demands of the patient. Many surgical approaches, fixation techniques, and potential complications have been described in the literature; however, the relative incidence and associated characteristics of these complications have not been studied. The purpose of this study was to identify the prevalence of complications and reoperations after ORIF for intra-articular distal humeral fractures. We sought to provide practical guidance to surgeons and offer insights on the avoidance and prognosis of complications through a systematic review of the published literature over the past 20 years.

      Methods

      We performed a systematic review and meta-analysis of studies reporting complications and reoperation rates after ORIF for intra-articular distal humeral fractures. Subgroup analysis was conducted for complication rates between type 13B and 13C fractures, olecranon osteotomy and non-osteotomy approaches, and parallel and perpendicular plating.

      Results

      Eighty-three studies met the inclusion criteria (2362 elbows; 5 level II, 2 level III, and 76 level IV studies). The mean clinical follow-up period was 2.6 years. The majority of fractures were type C (83%), the remainder were type B (17%). Of the fractures, 71% were closed whereas 9% were open; this was not reported for 20%. The mean postoperative flexion arc was 110°. The overall complication rate was 53%, and the overall reoperation rate was 21%. Although a parallel plating approach resulted in a lower rate of fixation failure requiring revision (1% vs. 6%, P < .001), a perpendicular plating approach showed a significantly lower rate of overall complications (45% vs. 54%, P = .006). This was primarily driven by lower rates of wound dehiscence (0.1% vs. 5%, P < .001), neuropathy (9% vs. 13%, P = .03), and implant prominence (3% vs. 7%, P = .01).

      Conclusions

      This systematic review is the largest report of complications and reoperations of intra-articular distal humeral fractures after ORIF in the current literature. These results suggest that complications may be more frequent than previously understood. In contrast to prior small comparative studies, our study observed a significantly higher overall complication rate with parallel plating than with perpendicular plating. Perpendicular plating for intra-articular distal humeral fractures may be considered if adequate fixation and biomechanical stability can be achieved.

      Level of evidence

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Journal of Shoulder and Elbow Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ali A.M.
        • Hassanin E.Y.
        • El-Ganainy A.E.
        • Abd-Elmola T.
        Management of intercondylar fractures of the humerus using the extensor mechanism-sparing paratricipital posterior approach.
        Acta Orthop Belg. 2008; 74: 747-752
        • Asfuroğlu Z.M.
        • İnan U.
        • Ömeroğlu H.
        Open reduction and internal fixation in AO type C distal humeral fractures using olecranon osteotomy: functional and clinical results.
        Ulus Travma Acil Cerrahi Derg. 2018; 24: 162-167https://doi.org/10.5505/tjtes.2017.32916
        • Ashwood N.
        • Verma M.
        • Hamlet M.
        • Garlapati A.
        • Fogg Q.
        Transarticular shear fractures of the distal humerus.
        J Shoulder Elbow Surg. 2010; 19: 46-52https://doi.org/10.1016/j.jse.2009.07.061
        • Aslam N.
        • Willett K.
        Functional outcome following internal fixation of intraarticular fractures of the distal humerus (AO type C).
        Acta Orthop Belg. 2004; 70: 118-122
        • Athwal G.S.
        • Hoxie S.C.
        • Rispoli D.M.
        • Steinmann S.P.
        Precontoured parallel plate fixation of AO/OTA type C distal humerus fractures.
        J Orthop Trauma. 2009; 23: 575-580https://doi.org/10.1097/BOT.0b013e3181aa5402
        • Atif M.
        • Hasan O.
        • Mohib Y.
        • Rashid R.H.
        • Hashmi P.
        Does surgical approach affect outcome after fixation of intra-articular fractures of distal humerus? Retrospective cohort study from a level-1 trauma centre in a metropolitan city.
        Ann Med Surg (Lond). 2019; 43: 48-51https://doi.org/10.1016/j.amsu.2019.05.012
        • Azboy İ.
        • Bulut M.
        • Ancar C.
        • Demirtaş A.
        • Özkul E.
        • Gem M.
        • et al.
        The comparison of triceps-reflecting anconeus pedicle and olecranon osteotomy approaches in the treatment of intercondylar fractures of the humerus.
        Ulus Travma Acil Cerrahi Derg. 2016; 22: 58-65https://doi.org/10.5505/tjtes.2015.42948
        • Ballesteros-Betancourt J.R.
        • García-Tarriño R.
        • García-Elvira R.
        • Muñoz-Mahamud E.
        • Fernández-Valencia J.A.
        • Llusá-Pérez M.
        • et al.
        The anterior limited approach of the elbow for the treatment of capitellum and trochlea fractures: surgical technique and clinical experience in eight cases.
        Injury. 2020; 51: S103-S111https://doi.org/10.1016/j.injury.2020.02.008
        • Batheja J.
        • Katto M.S.
        • Ahmed M.W.
        • Jamil M.
        • Rajput I.M.
        • Siddiqui A.A.
        • et al.
        Dual plating osteosynthesis technique used for fixation of inter-condylar distal humerus fractures via transolecranon approach.
        J Liaquat Univ Med Health Sci. 2017; 16: 139-144https://doi.org/10.22442/jlumhs.171630522
        • Bergdahl C.
        • Ekholm C.
        • Wennergren D.
        • Nilsson F.
        • Möller M.
        Epidemiology and patho-anatomical pattern of 2,011 humeral fractures: data from the Swedish Fracture Register.
        BMC Musculoskelet Disord. 2016; 17: 159https://doi.org/10.1186/s12891-016-1009-8
        • Bhayana H.
        • Pandey R.
        • Dhammi I.K.
        • Baumann F.
        • Bhatia U.
        Comparative study for assessment of functional outcome of intraarticular AO type C distal humerus fractures treated by parallel plating.
        Indian J Orthop. 2019; 53: 190-195https://doi.org/10.4103/ortho.IJOrtho_298_18
        • Bilsel K.
        • Atalar A.C.
        • Erdil M.
        • Elmadag M.
        • Sen C.
        • Demirhan M.
        Coronal plane fractures of the distal humerus involving the capitellum and trochlea treated with open reduction internal fixation.
        Arch Orthop Trauma Surg. 2013; 133: 797-804https://doi.org/10.1007/s00402-013-1718-5
        • Biz C.
        • Sperotto S.P.
        • Maschio N.
        • Borella M.
        • Iacobellis C.
        • Ruggieri P.
        The challenging surgical treatment of closed distal humerus fractures in elderly and octogenarian patients: radiographic and functional outcomes with a minimum follow-up of 24 months.
        Arch Orthop Trauma Surg. 2017; 137: 1371-1383https://doi.org/10.1007/s00402-017-2762-3
        • Brouwer K.M.
        • Guitton T.G.
        • Doornberg J.N.
        • Kloen P.
        • Jupiter J.B.
        • Ring D.
        Fractures of the medial column of the distal humerus in adults.
        J Hand Surg Am. 2009; 34: 439-445https://doi.org/10.1016/j.jhsa.2008.11.022
        • Bryan R.S.
        • Morrey B.F.
        Extensive posterior exposure of the elbow. A triceps-sparing approach.
        Clin Orthop Relat Res. 1982; : 188-192
        • Chen D.
        • Huang X.
        • Liu J.
        • Li S.
        The outcome comparison of headless screws and mini-plate for treating type B3 distal humerus fractures.
        Acta Orthop Belg. 2019; 85: 72-78
        • Chou Y.C.
        • Hsu Y.H.
        • Yu Y.H.
        • Wu C.C.
        Triceps-reflecting anconeus pedicle approach with double precontoured locking plate fixation is efficient in the treatment of orthopaedic trauma association type C distal humerus fracture.
        Injury. 2016; 47: 2240-2246https://doi.org/10.1016/j.injury.2016.06.036
        • Corradi A.
        • Talamonti T.
        • Cabitza P.
        • Bottiglieri G.
        • Secondi F.
        Innovative techniques for the osteosynthesis of distal humeral fractures.
        Injury. 2010; 41: 1117-1119https://doi.org/10.1016/j.injury.2010.09.022
        • Dehghan N.
        • Furey M.
        • Schemitsch L.
        • Ristevski B.
        • Goetz T.
        • Schemitsch E.H.
        • et al.
        Long-term outcomes of total elbow arthroplasty for distal humeral fracture: results from a prior randomized clinical trial.
        J Shoulder Elbow Surg. 2019; 28: 2198-2204https://doi.org/10.1016/j.jse.2019.06.004
        • Dubberley J.H.
        • Faber K.J.
        • Macdermid J.C.
        • Patterson S.D.
        • King G.J.
        Outcome after open reduction and internal fixation of capitellar and trochlear fractures.
        J Bone Joint Surg Am. 2006; 88: 46-54https://doi.org/10.2106/jbjs.D.02954
        • Egol K.A.
        • Tsai P.
        • Vazques O.
        • Tejwani N.C.
        Comparison of functional outcomes of total elbow arthroplasty vs plate fixation for distal humerus fractures in osteoporotic elbows.
        Am J Orthop (Belle Mead NJ). 2011; 40: 67-71
        • Ek E.T.
        • Goldwasser M.
        • Bonomo A.L.
        Functional outcome of complex intercondylar fractures of the distal humerus treated through a triceps-sparing approach.
        J Shoulder Elbow Surg. 2008; 17: 441-446https://doi.org/10.1016/j.jse.2007.08.012
        • Ellwein A.
        • Lill H.
        • Voigt C.
        • Wirtz P.
        • Jensen G.
        • Katthagen J.C.
        Arthroplasty compared to internal fixation by locking plate osteosynthesis in comminuted fractures of the distal humerus.
        Int Orthop. 2015; 39: 747-754https://doi.org/10.1007/s00264-014-2635-0
        • Elmadag M.
        • Erdil M.
        • Bilsel K.
        • Acar M.A.
        • Tuncer N.
        • Tuncay I.
        The olecranon osteotomy provides better outcome than the triceps-lifting approach for the treatment of distal humerus fractures.
        Eur J Orthop Surg Traumatol. 2014; 24: 43-50https://doi.org/10.1007/s00590-012-1149-y
        • Eralp L.
        • Kocaoglu M.
        • Sar C.
        • Atalar A.C.
        Surgical treatment of distal intraarticular humeral fractures in adults.
        Int Orthop. 2001; 25: 46-50
        • Fernández-Valencia J.A.
        • Muñoz-Mahamud E.
        • Ballesteros J.R.
        • Prat S.
        Treatment of AO type C fractures of the distal part of the humerus through the Bryan-Morrey triceps-sparing approach.
        ISRN Orthop. 2013; 2013: 525326https://doi.org/10.1155/2013/525326
        • Flinkkilä T.
        • Toimela J.
        • Sirniö K.
        • Leppilahti J.
        Results of parallel plate fixation of comminuted intra-articular distal humeral fractures.
        J Shoulder Elbow Surg. 2014; 23: 701-707https://doi.org/10.1016/j.jse.2014.01.017
        • Frankle M.A.
        • Herscovici Jr., D.
        • DiPasquale T.G.
        • Vasey M.B.
        • Sanders R.W.
        A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraarticular distal humerus fractures in women older than age 65.
        J Orthop Trauma. 2003; 17: 473-480https://doi.org/10.1097/00005131-200308000-00001
        • Frattini M.
        • Soncini G.
        • Corradi M.
        • Panno B.
        • Tocco S.
        • Pogliacomi F.
        Mid-term results of complex distal humeral fractures.
        Musculoskelet Surg. 2011; 95: 205-213https://doi.org/10.1007/s12306-011-0132-9
        • Garg S.
        • Sain A.
        • Sharma V.
        • Farooque K.
        • Rangaswamy N.
        Functional outcome of a coronal shear fracture of the capitellum managed by Herbert screw fixation using the anterolateral surgical approach.
        Cureus. 2020; 12: e6578https://doi.org/10.7759/cureus.6578
        • Gofton W.T.
        • Macdermid J.C.
        • Patterson S.D.
        • Faber K.J.
        • King G.J.
        Functional outcome of AO type C distal humeral fractures.
        J Hand Surg Am. 2003; 28: 294-308https://doi.org/10.1053/jhsu.2003.50038
        • Govindasamy R.
        • Shekhawat V.
        • Banshiwal R.C.
        • Verma R.K.
        Clinico-radiological outcome analysis of parallel plating with perpendicular plating in distal humeral intra-articular fractures: prospective randomised study.
        J Clin Diagn Res. 2017; 11: Rc13-Rc16https://doi.org/10.7860/jcdr/2017/22262.9423
        • Greiner S.
        • Haas N.P.
        • Bail H.J.
        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 Surg. 2008; 128: 723-729https://doi.org/10.1007/s00402-007-0428-2
        • Gupta R.
        • Khanchandani P.
        Intercondylar fractures of the distal humerus in adults: a critical analysis of 55 cases.
        Injury. 2002; 33: 511-515https://doi.org/10.1016/s0020-1383(02)00009-8
        • Henley M.B.
        • Bone L.B.
        • Parker B.
        Operative management of intra-articular fractures of the distal humerus.
        J Orthop Trauma. 1987; 1: 24-35
        • Houben P.F.
        • Bongers K.J.
        • vd Wildenberg F.A.
        Double tension band osteosynthesis in supra- and transcondylar humeral fractures.
        Injury. 1994; 25: 305-309
        • Huang J.I.
        • Paczas M.
        • Hoyen H.A.
        • Vallier H.A.
        Functional outcome after open reduction internal fixation of intra-articular fractures of the distal humerus in the elderly.
        J Orthop Trauma. 2011; 25: 259-265https://doi.org/10.1097/BOT.0b013e3181dfd348
        • Huang T.L.
        • Chiu F.Y.
        • Chuang T.Y.
        • Chen T.H.
        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: 62-69https://doi.org/10.1097/01.ta.0000154058.20429.9c
        • Jeong B.-O.
        • Lee D.
        Treatment for type C fractures of the distal humerus with the LCP distal humerus system.
        Eur J Orthop Surg Traumatol. 2011; 22https://doi.org/10.1007/s00590-011-0893-8
        • Jung S.W.
        • Kang S.H.
        • Jeong M.
        • Lim H.S.
        Triangular fixation technique for bicolumn restoration in treatment of distal humerus intercondylar fracture.
        Clin Orthop Surg. 2016; 8: 9-18https://doi.org/10.4055/cios.2016.8.1.9
        • Jupiter J.B.
        • Barnes K.A.
        • Goodman L.J.
        • Saldaña A.E.
        Multiplane fracture of the distal humerus.
        J Orthop Trauma. 1993; 7: 216-220
        • Jupiter J.B.
        • Neff U.
        • Holzach P.
        • Allgöwer M.
        Intercondylar fractures of the humerus. An operative approach.
        J Bone Joint Surg Am. 1985; 67: 226-239
        • Jupiter J.B.
        • Neff U.
        • Regazzoni P.
        • Allgower M.
        Unicondylar fractures of the distal humerus: an operative approach.
        J Orthop Trauma. 1988; 2: 102-109
        • Kaiser T.
        • Brunner A.
        • Hohendorff B.
        • Ulmar B.
        • Babst R.
        Treatment of supra- and intra-articular fractures of the distal humerus with the LCP Distal Humerus Plate: a 2-year follow-up.
        J Shoulder Elbow Surg. 2011; 20: 206-212https://doi.org/10.1016/j.jse.2010.06.010
        • Kim S.H.
        • Szabo R.M.
        • Marder R.A.
        Epidemiology of humerus fractures in the United States: nationwide emergency department sample, 2008.
        Arthritis Care Res (Hoboken). 2012; 64: 407-414https://doi.org/10.1002/acr.21563
        • Korner J.
        • Lill H.
        • Müller L.P.
        • Hessmann M.
        • Kopf K.
        • Goldhahn J.
        • et al.
        Distal humerus fractures in elderly patients: results after open reduction and internal fixation.
        Osteoporos Int. 2005; 16: S73-S79https://doi.org/10.1007/s00198-004-1764-5
        • Kural C.
        • Ercin E.
        • Erkilinc M.
        • Karaali E.
        • Bilgili M.G.
        • Altun S.
        Bicolumnar 90-90 plating of AO 13C type fractures.
        Acta Orthop Traumatol Turc. 2017; 51: 128-132https://doi.org/10.1016/j.aott.2016.09.003
        • Lakhey S.
        • Sharma S.
        • Pradhan R.L.
        • Pandey B.K.
        • Manandhar R.R.
        • Rijal K.P.
        Osteosynthesis of intercondylar humerus fracture using Bryan and Morrey approach.
        Kathmandu Univ Med J (KUMJ). 2010; 8: 154-157https://doi.org/10.3126/kumj.v8i2.3549
        • Lan X.
        • Zhang L.H.
        • Tao S.
        • Zhang Q.
        • Liang X.D.
        • Yuan B.T.
        • et al.
        Comparative study of perpendicular versus parallel double plating methods for type C distal humeral fractures.
        Chin Med J (Engl). 2013; 126: 2337-2342
        • Lee S.K.
        • Jeung S.W.
        • Chun Y.S.
        • Choy W.S.
        Headless compression screw fixation for type 2 and 3 articular surface fractures of the distal humerus using transolecranon approach.
        Acta Orthop Belg. 2019; 85: 448-458
        • Lee S.K.
        • Kim K.J.
        • Park K.H.
        • Choy W.S.
        A comparison between orthogonal and parallel plating methods for distal humerus fractures: a prospective randomized trial.
        Eur J Orthop Surg Traumatol. 2014; 24: 1123-1131https://doi.org/10.1007/s00590-013-1286-y
        • Leigey D.F.
        • Farrell D.J.
        • Siska P.A.
        • Tarkin I.S.
        Bicolumnar 90-90 plating of low-energy distal humeral fractures in the elderly patient.
        Geriatr Orthop Surg Rehabil. 2014; 5: 122-126https://doi.org/10.1177/2151458514526882
        • Li S.H.
        • Li Z.H.
        • Cai Z.D.
        • Zhu Y.C.
        • Shi Y.Z.
        • Liou J.
        • et al.
        Bilateral plate fixation for type C distal humerus fractures: experience at a single institution.
        Int Orthop. 2011; 35: 433-438https://doi.org/10.1007/s00264-010-1011-y
        • Liang J.
        • Wang M.
        • Zhao Y.
        • Xu L.
        • Li K.
        Factors affecting the functional outcome of open reduction and internal fixation on intercondylar distal humeral fractures in elderly patients.
        Eur J Orthop Surg Traumatol. 2011; 22https://doi.org/10.1007/s00590-011-0872-0
        • Liu J.J.
        • Ruan H.J.
        • Wang J.G.
        • Fan C.Y.
        • Zeng B.F.
        Double-column fixation for type C fractures of the distal humerus in the elderly.
        J Shoulder Elbow Surg. 2009; 18: 646-651https://doi.org/10.1016/j.jse.2008.12.012
        • Mahapatra S.
        • Abraham V.T.
        Functional results of intercondylar fractures of the humerus fixed with dual Y-plate; a technical note.
        Bull Emerg Trauma. 2017; 5: 36-41
        • Majeed F.
        • Saddique M.
        • Tanveer F.
        • Ahmad A.
        Surgical treatment for distal humerus fractures in adults (type C fractures) by tricep tongue lifting (V-Y PLASTY) approach.
        Rawal Med J. 2019; 44: 541-543
        • Mardanpour K.
        • Rahbar M.
        Open reduction and internal fixation of intraarticular fractures of the humerus: evaluation of 33 cases.
        Trauma Monthly. 2013; 17: 396-400https://doi.org/10.5812/traumamon.5278
        • McKee M.D.
        • Jupiter J.B.
        • Bamberger H.B.
        Coronal shear fractures of the distal end of the humerus.
        J Bone Joint Surg Am. 1996; 78: 49-54
        • McKee M.D.
        • Veillette C.J.
        • Hall J.A.
        • Schemitsch E.H.
        • Wild L.M.
        • McCormack R.
        • et al.
        A multicenter, prospective, randomized, controlled trial of open reduction–internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients.
        J Shoulder Elbow Surg. 2009; 18: 3-12https://doi.org/10.1016/j.jse.2008.06.005
        • McKee M.D.
        • Wilson T.L.
        • Winston L.
        • Schemitsch E.H.
        • Richards R.R.
        Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach.
        J Bone Joint Surg Am. 2000; 82: 1701-1707
        • Min W.
        • Ding B.C.
        • Tejwani N.C.
        Comparative functional outcome of AO/OTA type C distal humerus fractures: open injuries do worse than closed fractures.
        J Trauma Acute Care Surg. 2012; 72: E27-E32https://doi.org/10.1097/ta.0b013e31821915ae
        • Mishra P.
        • Aggarwal A.
        • Rajagopalan M.
        • Dhammi I.
        • Jain A.K.
        Critical analysis of triceps-reflecting anconeus pedicle (TRAP) approach for operative management of intra-articular distal humerus fractures.
        J Clin Orthop Trauma. 2010; 1: 71-80https://doi.org/10.1016/S0976-5662(11)60016-7
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS Med. 2009; 6: e1000097https://doi.org/10.1371/journal.pmed.1000097
        • Obremskey W.T.
        • Pappas N.
        • Attallah-Wasif E.
        • Tornetta P.I.
        • Bhandari M.
        Level of evidence in orthopaedic journals.
        J Bone Joint Surg Am. 2005; 87: 2632-2638https://doi.org/10.2106/jbjs.E.00370
        • Ozer H.
        • Solak S.
        • Turanli S.
        • Baltaci G.
        • Colakoğlu T.
        • Bolukbasí S.
        Intercondylar fractures of the distal humerus treated with the triceps-reflecting anconeus pedicle approach.
        Arch Orthop Trauma Surg. 2005; 125: 469-474https://doi.org/10.1007/s00402-005-0026-0
        • Pajarinen J.
        • Björkenheim J.M.
        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: 48-52https://doi.org/10.1067/mse.2002.119390
        • Pankaj A.
        • Mallinath G.
        • Malhotra R.
        • Bhan S.
        Surgical management of intercondylar fractures of the humerus using triceps reflecting anconeus pedicle (TRAP) approach.
        Indian J Orthop. 2007; 41: 219-223https://doi.org/10.4103/0019-5413.33686
        • Patel J.
        • Motwani G.
        • Shah H.
        • Daveshwar R.
        Outcome after internal fixation of intraarticular distal humerus (AO type B & C) fractures: preliminary results with anatomical distal humerus LCP system.
        J Clin Orthop Trauma. 2017; 8: 63-67https://doi.org/10.1016/j.jcot.2017.02.004
        • Ravishankar M.R.
        • Kumar M.N.
        • Raut R.
        Choice of surgical approach for capitellar fractures based on pathoanatomy of fractures: outcomes of surgical management.
        Eur J Orthop Surg Traumatol. 2017; 27: 233-242https://doi.org/10.1007/s00590-016-1877-5
        • Ring D.
        • Gulotta L.
        • Chin K.
        • Jupiter J.B.
        Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus.
        J Orthop Trauma. 2004; 18: 446-449https://doi.org/10.1097/00005131-200408000-00010
        • Ring D.
        • Jupiter J.B.
        • Gulotta L.
        Articular fractures of the distal part of the humerus.
        J Bone Joint Surg Am. 2003; 85: 232-238https://doi.org/10.2106/00004623-200302000-00008
        • Robinson C.M.
        • Hill R.M.
        • Jacobs N.
        • Dall G.
        • Court-Brown C.M.
        Adult distal humeral metaphyseal fractures: epidemiology and results of treatment.
        J Orthop Trauma. 2003; 17: 38-47https://doi.org/10.1097/00005131-200301000-00006
        • Savvidou O.D.
        • Zampeli F.
        • Koutsouradis P.
        • Chloros G.D.
        • Kaspiris A.
        • Sourmelis S.
        • et al.
        Complications of open reduction and internal fixation of distal humerus fractures.
        EFORT Open Rev. 2018; 3: 558-567https://doi.org/10.1302/2058-5241.3.180009
        • Schildhauer T.A.
        • Nork S.E.
        • Mills W.J.
        • Henley M.B.
        Extensor mechanism-sparing paratricipital posterior approach to the distal humerus.
        J Orthop Trauma. 2003; 17: 374-378https://doi.org/10.1097/00005131-200305000-00009
        • Schindelar L.E.
        • Rondon A.J.
        • Ilyas A.M.
        Total elbow arthroplasty versus open reduction and internal fixation for the management of distal humerus fractures in the elderly.
        Orthopedics. 2019; 42: 22-27https://doi.org/10.3928/01477447-20181206-05
        • Shin S.J.
        • Sohn H.S.
        • Do N.H.
        A clinical comparison of two different double plating methods for intraarticular distal humerus fractures.
        J Shoulder Elbow Surg. 2010; 19: 2-9https://doi.org/10.1016/j.jse.2009.05.003
        • Singh R.
        • Kanodia N.
        • Singh H.
        Outcome following olecranon osteotomy versus paratricipital approach for complex intra-articular (AO 13-C) fracture of distal humerus: a prospective comparative study.
        J Shoulder Elbow Surg. 2019; 28: 742-750https://doi.org/10.1016/j.jse.2019.01.002
        • Södergård J.
        • Sandelin J.
        • Böstman O.
        Postoperative complications of distal humeral fractures. 27/96 adults followed up for 6 (2-10) years.
        Acta Orthop Scand. 1992; 63: 85-89
        • Somerson J.
        • Morrey M.
        • Sanchez-Sotelo J.
        • Morrey B.
        Predictors of reoperation after internal fixation of intra-articular distal humerus fractures.
        Shoulder Elbow. 2020; (175857321989597. https://doi.org/10.1177/1758573219895972)
        • Song Z.
        • Wang Q.
        • Ma T.
        • Wang C.
        • Yang N.
        • Xue H.
        • et al.
        Anti-sliding plate technique for coronal shear fractures of the distal humerus.
        J Orthop Surg Res. 2020; 15: 18https://doi.org/10.1186/s13018-019-1466-5
        • Soon J.L.
        • Chan B.K.
        • Low C.O.
        Surgical fixation of intra-articular fractures of the distal humerus in adults.
        Injury. 2004; 35: 44-54https://doi.org/10.1016/s0020-1383(02)00332-7
        • Stoffel K.
        • Cunneen S.
        • Morgan R.
        • Nicholls R.
        • Stachowiak G.
        Comparative stability of perpendicular versus parallel double-locking plating systems in osteoporotic comminuted distal humerus fractures.
        J Orthop Res. 2008; 26: 778-784https://doi.org/10.1002/jor.20528
        • Tanwar Y.S.
        • Kharbanda Y.
        • Jaiswal A.
        • Birla V.
        • Pandit R.
        Retrospective analysis of open reduction and internal fixation of coronal plane fractures of the capitellum and trochlea using the anterolateral approach.
        SICOT J. 2018; 4: 8https://doi.org/10.1051/sicotj/2017063
        • Tarallo L.
        • Mugnai R.
        • Adani R.
        • Zambianchi F.
        • Costanzini C.A.
        • Catani F.
        Shear fractures of the distal humerus: is the use of intra-articular screws a safe treatment?.
        Musculoskelet Surg. 2015; 99: 217-223https://doi.org/10.1007/s12306-015-0386-8
        • Tian D.
        • Jing J.
        • Qian J.
        • Li J.
        Comparison of two different double-plate fixation methods with olecranon osteotomy for intercondylar fractures of the distal humeri of young adults.
        Exp Ther Med. 2013; 6: 147-151https://doi.org/10.3892/etm.2013.1102
        • Tyllianakis M.
        • Panagopoulos A.
        • Papadopoulos A.X.
        • Kaisidis A.
        • Zouboulis P.
        Functional evaluation of comminuted intra-articular fractures of the distal humerus (AO type C). Long term results in twenty-six patients.
        Acta Orthop Belg. 2004; 70: 123-130
        • Virani S.R.
        • Sonone S.
        • Dahapute A.A.
        • Panda I.
        • Roy K.D.
        Functional results of communited intra-articular distal humerus fractures treated with bicolumnar plating.
        J Clin Diagn Res. 2017; 11: Rc01-Rc03https://doi.org/10.7860/jcdr/2017/20777.9666
        • Von Keudell A.
        • Kachooei A.R.
        • Moradi A.
        • Jupiter J.B.
        Outcome of surgical fixation of lateral column distal humerus fractures.
        J Orthop Trauma. 2016; 30: 245-250https://doi.org/10.1097/bot.0000000000000496
        • Wafai A.M.
        • Tank G.G.
        • Holdsworth B.J.
        Outcome of primary internal fixation of (type C) distal humerus fractures in the elderly.
        Eur J Orthop Surg Traumatol. 2006; 16: 114-119https://doi.org/10.1007/s00590-005-0060-1
        • Wang K.C.
        • Shih H.N.
        • Hsu K.Y.
        • Shih C.H.
        Intercondylar fractures of the distal humerus: routine anterior subcutaneous transposition of the ulnar nerve in a posterior operative approach.
        J Trauma. 1994; 36: 770-773
        • Wang P.
        • Kandemir U.
        • Zhang K.
        • Zhang B.
        • Song Z.
        • Huang H.
        • et al.
        Treatment of capitellar and trochlear fractures with posterior comminution: minimum 2-year follow-up.
        J Shoulder Elbow Surg. 2019; 28: 931-938https://doi.org/10.1016/j.jse.2018.09.004
        • Yadav V.
        • Sharma P.
        • Gohiya A.
        Functional outcome of intraarticular distal humerus fracture fixation using triceps-sparing paratricipital approach.
        Indian J Orthop. 2016; 50: 595-601https://doi.org/10.4103/0019-5413.193487
        • Yang K.H.
        • Park H.W.
        • Park S.J.
        • Jung S.H.
        Lateral J-plate fixation in comminuted intercondylar fracture of the humerus.
        Arch Orthop Trauma Surg. 2003; 123: 234-238https://doi.org/10.1007/s00402-003-0508-x
        • Yu T.
        • Tao H.
        • Xu F.
        • Hu Y.
        • Zhang C.
        • Zhou G.
        Comparison of lateral approach versus anterolateral approach with Herbert screw fixation for isolated coronal shear fractures of humeral capitellum.
        J Orthop Surg Res. 2019; 14: 230https://doi.org/10.1186/s13018-019-1261-3
        • Zhang C.
        • Zhong B.
        • Luo C.F.
        Comparing approaches to expose type C fractures of the distal humerus for ORIF in elderly patients: six years clinical experience with both the triceps-sparing approach and olecranon osteotomy.
        Arch Orthop Trauma Surg. 2014; 134: 803-811https://doi.org/10.1007/s00402-014-1983-y
        • Zhao J.
        • Wang X.
        • Zhang Q.
        Surgical treatment of comminuted intra-articular fractures of the distal humerus with double tension band osteosynthesis.
        Orthopedics. 2000; 23: 449-452