Outcomes in patients with fractures of distal humerus using allografts for bone defect replacement

Abstract Traumatic injuries of the elbow joint that lead to severe consequences are quite common. The complex anatomy of distal humerus and frequent intra-articular localization of the injury turn treatment challenging, and the positive outcome is often impossible without bone plasty. The aim of this study is to present the outcomes in patients with distal humerus fractures (DHF) using various grafts to repair their bone defects. Both retrospective and prospective investigations of the outcomes in 20 DHF patients aged 40.5±9.5 years were carried out. The prevailing injury mechanism was falling on the elbow joint, in 8 cases out of 20 the injury resulted from a sport activity, in 2 cases – from car accidents. The standard 2 projections radiography was used to determine AO fracture type and bone fragments positioning while 3D computed tomography helped in case of multi-fragment fractures. Surgical reconstruction of the affected segment was performed 13±6 days later with various bone fixators by placing parallel, mutually perpendicular plates and screws according to the AO guidelines. Bone defect plasty involved spongy cadaveric bone powder allografts, synthetic granules or allografts of resected femoral heads produced by the Marburg Bone Bank System. Those with powder allografts and synthetic granules were included in Group A, and patients with femoral allografts produced by the Marburg Bone Bank System made up Group B. The operated elbow joints were assessed in 6-8 weeks by the international Broberg and Morrey rating system. In Group A (n=10), 1 patient had an excellent outcome of the surgery, 4 had good outcomes and 5 had satisfactory outcomes. In Group B (n=10), 2 patients had excellent outcomes, 5 had good outcomes, and 3 had satisfactory outcomes. Therefore, the correct choice of treatment tactics along with the early surgical intervention followed by a short immobilization time and early passive exercises in the operated elbow joint benefit the treatment outcome.