Comparison of three internal fixation methods in treatment of type C3 fractures of distal humerus

Objective To evaluate three internal fixation methods in treatment of type C3 fractures of distal humerus.Methods From February 2002 to January 2005,73 cases of humeral intercondylar fractures were treated with single plating (Group A,21 cases),Y-shape plating (Group B,33 eases) and dual plating (Group C,19 cases).According to the AO/ASIF classification,73 cases belonged to type C3.The posterior midline incision and the approach of liguliform flap of musculus triceps brachii were used for all the cases.The recorded clinical data were reviewed to analyze effects of internal fixation methods,functions of the elbow and the complications.Results All the cases were followed up.The follow-ups ranged from 12 to 36 months,with an average of 22.3 months.By the end of the twelfth month,according to the Jupiter scoring system,the elhow function was excellent and good in 57.1% of cases in Group A,81.8% in Group B and 89.5% in Group C,the difference between Gronp A and Groups B and C being statistically significant(P＜0.05).Meanwhile,according to Sodergard's criteria for failure of internal fixation system for intercondylar fracture of humerus,the failure rate was 33.3% in Group A,15,2% in Group B and 5.3% in Group C.The loosening or breakage rate in Group C was significantly lower than in Groups A and B (P＜0.05),and that in Group B was obviously lower than in Group A (P＜0.05).No incision necrosis or deep infection occurred.Conclusions The type C3 fractures of distal humerus should not he treated with single plating,because the functional outcome of elbow joint is poor,and the rate of loosening or breakage of internal fixation is higher than other fixation methods.Y-shape plating and dual plating are good for them,but Y-shape plating is not good for severe intercondytar comminnted fractures of the humerus,because its peculiar shape tends to lead to a higher rate of loosening.