Results of Tension Band Wiring and Cancellous Screw In the Management of Old Displaced Intercondylar Fracture of Adult Humerus.

Dr. P. C. Debnath1, Dr. Syed Shahidul Islam2, Dr. Md. Subir Hossain3, Dr. Md Nazrul Islam4.
1. Associate professor MS(ortho), Shaheed Surhawardy Medical college Hospital. Dhaka. 2. Junior consultant ) MS(ortho), Shaheed Surhawardy Medical college Hospital. Dhaka. 3. Assistant Registrar (ortho), Shaheed Surhawardy Medical college Hospital. Dhaka. 4. Resident Surgeon, Shaheed Surhawardy Medical college Hospital. Dhaka. Bangladesh.

Abstract
Eleven (11) patients of more than 6(six) weeks old displaced Intercondylar Fracture of Humerus in adult were treated by open reduction and internal fixation with K wire and Cancellous Screw. Treatment of displaced intercondylar fracture of humerus by ORIF with tension band wiring is a challenging problem. Out of 11(eleven) cases 3(three) cases showed excellent result, 5(five) cases showed good result, 2(two) cases showed fair result and 1(one) had lost.The followup period was 6(six) months to 2(Two) years the average being 1(one) year and (3) three months.
1

Introduction
Old and displaced intercondylar fracture in adult present the most difficult challenge of the fracture of the lower end of the humerus. In displaced recent fracture conservative treatment by traction and manipulative compression may help to reduce and sometime be managed but in old and displaced fracture it is mandatary to do open reduction.In this series operative treatment consist of open reduction and internal fixation by tension band wiring with or without cancellous screw fixation. Cases had been selected from group C of ASIF group (Muller et al.1991) randomly and evaluated in respect to stability,pain, mobility and deformity suggested by Bickel and perry.

Materials and Method

The study had been carried out in the Shaheed Surhawardy Medical college hospital and Dr Azmol Hospital during the period of July 2006 to June 2008.11(eleven) patients were included in the series. There were 7(seven)63.64% of female and 4(four) 36.36% male and average age was 32(thirty two) ranging from 26-38 years. Left sided involvement was 6(six) and right sided was (5) patients. The cause of injury was road traffic accident and fall from height.

Approach
Campbells posterior approach was used in the series. Fragments were gently cleaned and apposed and fixed with K wire before cancellous screw fixation. Tension band wiring were applied through medial and lateral epicondyl to the distal humerus.wound was closed in layers keeping a drain which was removed after 48 hours.Long arm back slab was applied after the end of operation.

Follow up: At 10th post operative day all stiches were removed. At 4th
week plaster was removed and active movement was started.

Results
The results were analyzed on the basis of clinical and radiological findings. All cases were united. Excellent result was seen in 3(27.27%) cases and good result was seen in 5(45.45) cases. Satisfactory result was seen in 72.73% cases where fair result was seen in 2(18.18% ) cases. One case had lost from the series. Superficial skin infection was seen in 2(two) cases which was improved after two weeks. One case showed ulnar neuroprexia which completely recovered after six weeks and another had deep seated sepsis ended in stiffness of the elbow. Patient-1
Post operative X-Ray, Patient:1 Preoperative X-Ray, Patient:1

Six months after operation

Patient-2
Preoperative X-Ray, Patient: 2 Postoperative X-Ray, Patient: 2

Postoperative: Movement

Conclusion:
Old displaced intercondylar fracture is a difficult problem in management though acute displaced fracture can be managed efficiently by open reduction and rigid fixation. Previously old intercondylar facture was not usually managed surgically and end with stiff elbow but it is seen that open reduction and internal fixation with tension band wiring with or without cancellous screw gives good to excellence result in 73% cases as early movement can be given by tension band wiring than plate and screw.

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