Evaluation of Functional Outcome of Orthogonal Bicolumnar Plating for AO 13-C Intra-articular Distal Humerus Fractures in 25 Cases

Background: Intra-articular distal humerus fractures classified as AO/OTA type 13-C represent complex injuries that pose significant challenges to orthopedic surgeons due to articular comminution, metaphyseal instability, and a high propensity for postoperative elbow stiffness. Achieving anatomical reduction of the joint surface and stable bicolumnar fixation is essential to permit early mobilization and restore functional elbow motion. Orthogonal (90– 90) bicolumnar plating has been widely adopted as a fixation strategy to address these biomechanical demands; however, functional outcomes and complication profiles continue to be evaluated, particularly in relation to fracture complexity. Aim: To evaluate the functional outcome, radiological union, and complications associated with orthogonal bicolumnar plating in AO/OTA 13-C intra-articular distal humerus fractures. Materials and Methods: This prospective observational study included 25 adult patients with AO/OTA 13-C distal humerus fractures treated by open reduction and internal fixation using orthogonal bicolumnar plating. Patients with pathological fractures, associated vascular injuries, or prior elbow pathology were excluded. Functional outcomes were assessed using the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) score. Radiological union was evaluated on serial radiographs. Complications were documented systematically. Results: The majority of patients were males (64.00%) and sustained injuries due to high-energy trauma, predominantly road traffic accidents (60.00%). Fracture subtypes 13-C2 and 13-C3 were most common (36.00% each). Radiological union was achieved in 96.00% of cases, with no nonunion or implant failure. Based on MEPS, 48.00% of patients achieved excellent outcomes and 32.00% achieved good outcomes, yielding an overall excellent-to-good rate of 80.00%. Increasing fracture complexity was significantly associated with poorer functional outcomes (p = 0.031). The mean MEPS was 85.20 ± 10.45, and the mean DASH score was 18.40 ± 7.90, with a strong negative correlation between the two (r = −0.72; p < 0.001). Elbow stiffness was the most common complication (16.00%). Conclusion: Orthogonal bicolumnar plating is an effective and reliable method for managing AO/OTA 13-C distal humerus fractures, providing high union rates and favorable functional outcomes. Despite increased fracture complexity being associated with reduced function, acceptable complication rates and satisfactory recovery can be achieved with meticulous surgical technique and early rehabilitation.