July – August 2019/ Vol 5/ Issue 3 Print ISSN: 2456-9518, Online ISSN: 2455-5436 Research Article Surgical Update: International Journal of Surgery & Orthopedics Available online at: www.medresearch.in 132 | Page Technical tip: fixation of extra-articular fractures of distal humerus with modified distal tibial locking plate Gupta R. 1 , Maheshwari V. 2 , Gour S. 3 , Narendra Kumar 4 , Singh A. 5 1 Dr. Rajul Gupta, Assistant Professor, 2 Dr. Vaibhav Maheshwari, Assistant Professor, 3 Dr. Sandeep Gour, Senior Resident, 4 Dr. Narendra Kumar, Associate Professor; above authors are attached with Department of Orthopaedics, Chirayu Medical College and Hospital, Bhopal (M.P.), 5 Dr. Avtar Singh, Director, Amandeep Hospital, Amritsar, Punjab, India. Corresponding Author: Dr. Vaibhav Maheshwari, Assistant Professor, Department of Orthopaedics, Chirayu Medical College & Hospital, Bhopal (M.P.) E-mail:drvaibhavm16@gmail.com ………………………………………………………………………………………………………………………............... Abstract Introduction- Treatment of extra-articular distal humerus fractures is often difficult using conventional plates. Plates having enough screws (three to four) in the distal fragment either impinge on the olecranon fossa, or gain purchase by placing screws in the lateral or medial column of the distal humerus avoiding the olecranon fossa. Objectives- This study was to ascertain the effectiveness of modified distal tibial locking plate for use in distal third shaft humerus fracture. Methods- By using a modified distal tibial locking plate, a six to eight locking head screws can be easily placed in the in the limited length of distal fragment proximal to the olecranon fossa. Fourteen cases treated in such manner were followed up for a minimum of 24 months. Results- Union was achieved in all cases with no loss of reduction or implant failure. No patient complained of hardware complication, functional limitation or infection. Conclusion- Modified distal locking plate can be safely used in the limited space above olecrenon fossa in distal thirds humerus shaft fractures Keywords: Distal humerus; Fracture; Plate fixation; Locking plate. ………………………………………………………………………………………………………………………............... Introduction Fractures of distal part of humerus are difficult to treat, despite recent advances in surgical technique [1]. Functional bracing, though advocated, may not provide adequate stability and acceptable alignment due to the distal extent of these fractures. Optimal treatment of these injuries is surgical, providing a predictable alignment quicker return to pre injury status [2] Stable fixation and reduced surgical time lead to fewer complications and allow earlier rehabilitation leading to a more predictable result. In the the clinical and functional outcomes using the extraarticular distal humerus plate in the management of extraarticular fractures of distal humerus were studied [3]. Anatomy of distal humerus is complex, and often the fracture pattern adds o the complexity of situation [4]. During open reduction and plate fixation, achieving purchase of 6 to 8 cortices on distal fragment often causes encroachment of olecranon fossa [5]. To address these problems, authors used a modified medial sided distal tibial locking compression plate (Kanghui, Jiangsu, China) for fixation of distalhumerus shaft fracture. The provision of multiple holes in plate meant for fixation of distal tibial fractures provides multiple screw fixation options in distal humerus improving distal fixation without encroachment on the olecranon fossa. Material and Methods Setting of the study- This study was performed in Chirayu Medical College and hospital, a tertiary level facility, under department of orthopaedics. Sample size- A total of 14 cases were included in this study. These include 11 cases of acute trauma and three non- unions. All non-unions were operated at least 12 months after trauma. Manuscript Received: 28 th May 2019 Reviewed: 5 th June 2019 Author Corrected: 10 th June 2019 Accepted for Publication: 14 th June 2019