RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BENGALURU, KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of Candidate Dr. HEGDE PRATEEK CHANDRAPRAKASH,

S/O Mr. HEGDE CHANDRAPRAKASH BHASKAR,
and
B-301,ADITYA APARTMENTS,
Address D.N.NAGAR,
(in block letters) OFF. J.P.ROAD,
ANDHERI (WEST),
MUMBAI – 400053.

2. Name of Institution J.J.M Medical College,

Davangere,
Karnataka.
PIN - 577004

3. Course of study and POST-GRADUATE DEGREE

subject M. S. ORTHOPAEDICS

4. Date of admission to 18th MAY 2012

course
5. Title of the Topic:
“SURGICAL MANAGEMENT OF INTERCONDYLAR FRACTURES OF
DISTAL END OF HUMERUS USING RECONSTRUCTION PLATES
THROUGH TRANS-OLECRANON APPROACH”
6. Brief resume of the intended work

6.1 Need for the study

Inter-Condylar Fractures of distal end of Humerus are uncommon injuries that

account for fewer than 2% of all adult fractures.

The complex anatomy of the elbow joint, the adjacent neurovascular

architecture and the sparse soft tissue envelop combine to make these fractures
difficult to treat1,2.

Fractures of distal end of Humerus continue to be challenging problem for

today’s surgeons despite advances in technique and implants.

Acceptable results have been reported in a majority of patients treated by Open

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Reduction and Internal Fixation3,4

Restoration of painless and satisfactory elbow function after a fracture of the

distal humerus requires anatomic reconstruction of the articular surfaces, restitution of
the overall geometry of the distal humerus and stable internal fixation of the
fractured fragments to allow early and full rehabilitation17,19,20,21

Reconstruction can be done according to two strategies :

i) Reduction and fixation of articular surfaces followed by attachment to

humeral shaft.
ii) Reduction and fixation of Medial and Lateral condyles to shaft, then
reconstruction of articular surfaces.

Depending upon frequency of communition and displacement, Open Reduction

and Internal Fixation with 1/3 tubular plate, Reconstruction plates, ‘K’ wire and
double Tension Band wiring can be done individually or in Combination or Elbow
Arthroplasty can be chosen.

The Aim of the present Study is to evaluate the Functional Outcome of

Surgical Management of Intercondylar Fractures of distal end of Humerus by Open
Reduction and Internal Fixation using Reconstruction Plates through Trans-Olecranon
approach.

6.2 Review of Literature

1. In early 2012, Joaquin Sanchez-Sotelo compared the outcome of Open Reduction

and Internal Fixation of distal end of Humerus with Elbow Arthroplasty and
found that Internal fixation is the preferred choice of treatment unless specific
indications for elbow arthroplasty existed.1

2. In 2011, Aaron Nauth et al and Babhulkar et al concluded that dual plate fixation
with placement of a separate strong plate on each column and orientation of the
plates either at 90 0 or 1800,is indicated for all adult fractures involving both
columns of distal part of Humerus.2,3,4

3. In 2010, Sang-Jin Shin et al conducted a comparative study between the two

different plating techniques available and concluded that although both
orthogonal and parallel plate provide adequate stability and anatomic
reconstruction, parallel plating holds a slight advantage over orthogonal plating
in terms of having better long-term results.5,6

4. In 2009, Atalar et al conducted a study on around 21 patients with distal end of

humerus fractures and functionally evaluated the outcome and concluded that
results are satisfactory when fractures are treated with stable osteosynthesis
and parallel plate technique that allows early motion, in congruence with other
studies conducted around that time.8,9,11

5. Among the Surgical Exposure options available, it was concluded that it

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 basically depends upon the Surgeons discretion but a Trans-Olecranon
approach gives a better visualization of the Fracture site and an easier
articular reconstruction opportunity compared to other approaches like Triceps-
Reflecting Anconeus Pedicle, Triceps Splitting or a Para-Tricipital
approach7,12,13,14,15,18,19

6. A high rate of union can be achieved in complex intra-articular fractures of

distal humerus if the proper principle of stable fracture fixation are followed
i.e. a posterior trans-olecranon approach and dual fixation of both columns
and restoration of continuity of articular surfaces. The stability achieved by this
technique permits institution of early intensive physiotherapy to restore elbow
function.10,16,17,20

7. In 2000, David Ring and Jesse B. Jupiter advocated the use of two 3.5mm
reconstruction plates for the T and H shaped fractures of the distal humerus.
They reviewed the result of treatment in 13 patients and obtained results which
are comparable with other recent series.20,21

6.3 Objectives of the study

1. To study the functional outcome of Surgical Management of Intercondylar

Fractures of distal end of Humerus using Reconstruction Plates through a
Trans-Olecranon approach.

2. To study the Advantages and Complications of the Procedure.

7. Materials and methods

7.1 Source of data

Patients with Intercondylar Fractures of distal end of Humerus admitted to

Chigateri General Hospital and Bapuji Hospital attached to J.J.M. Medical College,
Davangere will be taken for this study after obtaining their informed written
consent.

This is a prospective study from July 2012 to June 2014.

7.2 Method of collection of data(including sampling procedure, if any)

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 • All adult patients with distal humerus fractures who are willing for surgery,
and admitted during the period of study.

• Patients will be Clinically and Radiologically evaluated pre-operatively and

post-operatively

• The patients will be assessed with the help of Mayo Elbow Performance Score
(MEPS) post-operatively

• Laboratory investigations will be carried out.

• Informed written consent of the patient will be taken for Surgical

Management.

Instrument details:

In our study we will be using 3.5 mm reconstruction plates of appropriate size

which will be contoured according to the need and appropriate size cortical screws
along with Kirschner wires and stainless steel wires for tension band wiring of
osteotomised olecranon .

Inclusion criteria:

• Male and Female Adult patients with Intercondylar fractures of distal end of
Humerus, who have given their consent for the procedure.

• Patient who are medically fit for Surgery.

Exclusion criteria:

• Patients medically unfit for Surgery.

• Patients not willing for Surgery.

• Compound Fractures and Old Fractures are not included.

Statistical Tests:

The collected data will be evaluated using appropriate statistical methods.

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7.3 Does the study require any investigations or interventions to be conducted on
patients or other humans or animals? If so, please describe briefly.

YES
The study requires
• Routine Blood Investigations

• Special Blood Investigations like HIV – I and II, HBsAg.

• ECG.

• X-Ray : Elbow joint - AP and Lateral view.

• Surgical Intervention is necessary.

• Post-Operative X-rays also needed at Regular Intervals in the Follow-Up

period..

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

YES

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8. List of references

1. Sanchez-Sotelo. Distal Humerus Fractures : Role of Internal Fixation and Elbow

Arthroplasty. J Bone Joint Surg Am 2012;94-A(6): 556-568.

2. Nauth A,McKee MD, Ristevski B, Hall J, Schemitsch. Distal Humerus Fractures :

Current Concepts Review. J Bone Joint Surg Am 2011;93(7):686-700.

3. Babhulkar S, Babhulkar S. Controversies in the management of intra-articular

fractures of distal humerus in adults. Indian J Orthop 2011;45:216-25.

4. Trikha V,Goyal T. Intercondylar Humerus Fractures: Current concepts and

controversies. J Clin. Ortho and Trauma Dec 2010;Vol 1 (2) : 57-65.

5. Galano GJ, Ahmad C S, Levine WN. Current treatment strategies for bicolumnar
distal humerus fractures. J Am Acad Orthop Surg 2010;18:20-30.

6. 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 and Elbow Surgery
2010;19:02-09.

7. Cheung EV, Steinmann, SP. Surgical approaches to the elbow -Review article. J Am
Acad Orthop Surg 2009;17:325-33.

8. Atalar AC, Demirhan M, Salduz A, Kilicoglu O, Seyahi A. Functional results of the

parallel plating for complex distal humerus fractures. Acta Orthop Traumatol
Turc 2009;43:21-27.

9. Arnander MW, Reeves A, MacLeod IA, Pinto TM, Khaleel A. A biomechanical

comparison of plate configuration in distal humerus fractures. J Orthop Trauma
2008;22:332-336.

10. Pollock JW, Faber KJ, Athwal GS. Distal Humerus Fractures. Orthop Clin of North
Am 2008;39(2):187-200.

11. Sanchez-Sotelo J, Torchia ME, O'Driscoll SW. Complex distal humeral fractures:
Internal fixation with a principle-based parallel-plate. Surgical technique. J Bone
Joint Surg Am 2008;90:31-46.

12. Coles CP, Barei DP, Sean E, Nork SE, Taitsman LA, Hanel DP. The Olecranon
Osteotomy: A Six-year Experience in the Treatment of Intraarticular Fractures of the
Distal Humerus. J Orthop Trauma 2006;20:164-71.

13. Aslan N. Surgical Fixation of Intra-articular fractures of distal humerus in adults.

Injury 2005;36:804-5.

14. Anglen J. Distal humerus fractures surgical techniques. J Am Acad Orthop Surg
2005;13:291-297.

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15. Ring D, Gulotta L, Chin K, Jupiter JB. Olecranon osteotomy for exposure of
fractures and nonunions of the distal humerus. J Orthop Trauma 2004;18:446-449.

16. Korner J, Diederichs G, Arzdorf M, Lill H, Josten C, Schneider E. Biomechanical

evaluation of methods of distal humerus fracture fixation using locking
compression plates versus conventional reconstruction plates. J Orthop Trauma
2004;18:286-93.

17. O'Driscoll SW, Sanchez-Sotelo J, Torchia ME. Management of the smashed distal
humerus. Orthop Clin North Am 2002;33:19-33.

18. Wilkinson JM, Stanley D. Posterior surgical approaches to the elbow: A comparative
anatomic study. J Shoulder Elbow Surg 2001;10:380-82.

19. McKee MD, Wilson TL, Winston L, Schemitsch EH, Richards RR. Functional
outcome following surgical treatment of intra-articular distal humeral fractures
through a posterior approach. J Bone Joint Surg Am 2000;82:1701-1707.

20. Ring D, Jupiter JB. Fractures of Distal Humerus. Orthop Clin North Am
2000;31(1):103-113.

21. Jupiter JB, Neff U, Holzach P, Allgower M. Intercondylar fractures of the humerus.
An operative approach. J Bone Joint Surg Am 1985;67:226-39.

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9. Signature of Candidate

10. Remarks of the Guide Intercondylar Fractures of distal end of

11. Name and Designation of the
Guide (in block letters).
11.1 Guide
11.2 Signature
Humerus are relatively complicated fractures,
requiring precise fixation of fracture fragments.
This Trans-Olecranon approach gives
adequate exposure of distal humerus allowing
good internal fixation with the help of
reconstruction plates.
Dr. VIJAYAKUMAR . S. KULAMBI,
M. S. (ORTHOPAEDICS),
PROFESSOR,
DEPARTMENT OF ORTHOPAEDICS,
J.J.M MEDICAL COLLEGE,
DAVANGERE – 577004.

11.3 Head Of the Department. Dr. G.NAGARAJ,

M. S. (ORTHOPAEDICS),
PROFESSOR and HOD,
DEPARTMENT OF ORTHOPAEDICS,
J.J.M MEDICAL COLLEGE,
DAVANGERE – 577004.
11.4 Signature

12. 12.1 Remarks of the

Chairman & Principal

12.2 Signature

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