Article

Intra-articular distal humerus fractures.

Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1070, USA.
Orthopedic Clinics of North America (Impact Factor: 1.7). 01/2013; 44(1):35-45. DOI: 10.1016/j.ocl.2012.08.010
Source: PubMed

ABSTRACT Distal humeral fractures are relatively rare and complex injuries. With appropriate preoperative planning and execution of surgical technique, good outcomes may be obtained in most patients. Patients should be counseled regarding loss of motion in these injuries, and elderly, osteoporotic patients with extensive comminution should be considered for total elbow arthroplasty as an alternative to open reduction and internal fixation.

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    ABSTRACT: Distal humeral fractures represent 2% of all adult elbow fractures. Injury mechanisms include high-energy trauma with skin involvement, and low energy trauma in osteoporotic bone. Treatment goals are anatomical restoration in young, high-demand patients and quick recovery of activities of daily living in the elderly. Complete fractures are relatively easy to diagnose, but partial intra-articular fractures are not. The clinical diagnosis must take into account potential complications such as open injuries and ulnar nerve trauma. Standard X-rays with additional distraction series in the operating room are sufficient in complete articular fracture cases. Partial intra-articular fractures will need CT scan and 3D reconstruction to fully evaluate the involved fragments. SOFCOT, AO/OTA and Dubberley classifications are the most useful for describing fractures and selecting treatment. Surgery is the optimal treatment and planning is based on fracture type. Complete fractures are treated using a posterior approach. Triceps management is a function of fracture lines and type of fixation planned. Constructs using two plates at 90° or 180° are the most stable, with additional frontal screw for intercondylar fractures. Elbow arthroplasty may be indicated in selected patients, having severely communited distal humerus fractures and osteoporotic bone. Open fractures make fixation and wound management more challenging and unfortunately have poorer outcomes. Other complications are elbow stiffness, non-union, malunion and heterotopic ossification.
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