Fracture of the Humeral Palette in Adult Patient: Therapeutic and Evolutive Aspect at Gabriel Touré Hospital: About 35 Cases ()
1. Introduction
Fractures of the humeral pallet occur between the distal insertion of the anterior brachial muscle and the joint space of the elbow [1] . It represents 2% of all elbow fractures [1] [2] . The incidence of this fracture increases with the severity of the trauma especially in the male age group of 10 to 30 years [2] .
These lower humeral fractures present a therapeutic challenge to trauma [1] [2] . These fractures are in the majority of joint cases and can be accompanied by loss of substance, which makes their functional prognosis random despite the application of the main therapeutic principles: exact reduction with possible bone graft; stable osteosynthesis, usually allowing early rehabilitation [2] . This work focused on identifying therapeutic aspects and assessing treatment outcomes.
2. Material and Methods
It was a descriptive cross-sectional study concerning patients with a fracture of the humeral palette from January 2015 to December 2019 at the Orthopaedic-Traumatology Department CHU Gabriel Touré Bamako.
We included all patients with a fracture of the humeral palette whose treatment and follow-up were performed in the department.
Clinical, para-clinical and developmental information was collected from patient records and follow-up in consultation. For each patient the following data were noted: age, gender, etiology of the trauma, mechanism, standard X-rays of the elbow face and profile for diagnosis and specify the pathological type according to the AO classification, associated lesions, skin lesions according to Gustilo and Anderson, admission time, time between trauma and osteosynthesis, type of treatment, physiotherapy protocol, and functional outcome according to the Mayo-clinic (Table 1).
We did not include patients under the age of 16, recoil under the age of 18 months, and lost-sight patients.
Data management and analysis was done according to SPSS 20.0, Word and Excel 2010.
The confidentiality of the data was respected with the approval of the ethics committee of the Faculty of Medicine and Dentistry of the University of Sciences, Techniques and Technologies of Bamako.
![]()
Table 1. Mayo-clinic performance score.
3. Results
We have collected 35 cases. The socio-demographic features of patients are summarized in Table 2.
The causes were falls with 19 cases (54.3%), road accidents in 13 cases (37.1%), 1 sports accident (2.8%) and 1 work accident case.
The lesion was located on the left in 24 cases (68.6%) and on the right in 11 cases (31.4%). Pathological types were type A (45.7%) (Figure 1), type B in 11.4%, and type C in 42.9% (Figure 2). We observed 15 cases of associated lesions (42.85%). There were 5 other segment fractures (14.28%), 3 open fracture cases (8.57%) of which Gustilo and Anderson type 1 (2 cases) and type 2 (1 case), 4 elbow dislocation cases (11.42%) and 3 polytrauma cases (8.57%). We performed surgical treatment in 80% and orthopedic treatment (brachio-antibrachiopalmar and posterior splint) in 20%. General anesthesia was performed in 26 patients with 92.85% and axillary block surgery in 2 patients (7.14%).
All our patients benefited from ceftriaxone-based antibiotic prophylaxis 2 g induction before inflating the pneumatic tourniquet. We performed osteosynthesis by screw plate in 14 cases (40%) (Figure 3), screwing in 8 cases (23%), screwing in 3 cases (8%) and external fixing in 3 cases (8%).
We recorded 18 cases of stiffness of the elbow (51.42%), 5 cases of secondary displacement (14.3%) linked to osteosynthesis deficiency, extra articular vicious cal in 4 cases (11.42%) related to insufficient reduction of orthopedic treatment, 4 cases of ossification of the elbow (11.42%) due to the deperiorisation (Figure 4), 3 cases of sepsis (8.6%), pseudosteoarthritis septic in 1 case. According to the functional score of the Mayo-clinic, we obtained an average decrease of 3.2 years, 47.5% good results.
4. Comments and Discussion
The limitations of this study are: sample size, failure to perform a CT scan for full injury equilibrium, and insufficient recoil for functional assessment.
In our series, the average age of patients was 39.25 years. This is consistent with the literature [3] [4] [5] [6] . The left side was the most reached with a frequency of 68.6%, according to the literature [7] , There is no predominance of side over other. Falls made up 54.3% of the etiologies in our study. Their main etiology followed by stroke [8] . In the literature bone lesions represent in the fractured poly 9% of cases for LECESTRE [9] and 38.5% for SARAGAGLIA [10] . We report a rate of 23%.
![]()
Figure 1. X-ray of the right elbow face and profile: Type A being consolidated.
![]()
Figure 2. X-ray of the right elbow face and profile: fracture type C.
![]()
(a) ![]()
(b)
Figure 3. (a): Trans-tricipital surgical view with ulnar nerve neurolysis, (b): Anatomical screwed plate placement.
![]()
Figure 4. Type C distal end left humerus fracture consolidated with ossification and removal of anatomically screwed plate.
![]()
Table 2. The socio-demographic features of patients.
In our series the supracondylar fractures represented 45.7%. But the joint fractures combined are the most represented (54.3%). Our results are higher than those of Mauriceau et al. [11] and Bilsel et al. [12] which find 20% and 27.7% respectively. This could be explained by the fragility of the epiphyseal zone and the mechanism of trauma with the energy that accompanies it.
In our series the surgical treatment was performed in 80% of cases. This surgical treatment recommended by many authors [8] [9] [10] [12] should meet the principles of the treatment of joint fractures: stability, mobility and indolence enabling early rehabilitation. The complex joint lesions explain this high frequency of surgical treatment and the improvement of the technical platform.
Joint stiffness was the most common complication (51.42%). Our results are higher than those of Chantelot et al. [4] and Ouzaa M R and et al. [13] which report elbow stiffness in 21% and 10% respectively. This high rate is explained on the one hand by the frequency of complex lesions, orthopedic treatment as well as open fractures whose treatment requires additional immobilization and on the other hand by the insufficiency of the rehabilitation of the elbow. We observed 8.7% superficial infection. This rate is relatively low, but higher than those of Ouzaa et al. [13] which find 4% but lower than that of Illical E M et al. [14] with 10%. We achieved 47.5% good functional results according to Mayo-clinic. Our results are well below the literature [4] [5] [12] [13] [14] .
5. Conclusion
Fractures of the humeral palette are frequently accompanied by associated lesions. Joint fractures are the most common and often complex. The frequency of associated lesions makes treatment difficult with an unfavourable evolution.
Authors’ Contributions
All authors contributed to this work. All authors also report having read and approved the final version of the manuscript.