Introduction Open treatment of extra-articular and intra-articular distal humeral fractures can be effectively accomplished through an extensor mechanism-on approach.
Step 1: Preoperative Planning Assess all images for multiplane fracture lines involving the capitellum or trochlea.
Step 2: Operative Setup Verify with fluoroscopy that the patient and arm positions allow for adequate imaging of the distal part of the humerus.
Step 3: Surgical Approach Perform medial and lateral arthrotomies posterior to the collateral ligament complexes and excise the intra-articular fat pad and posterior aspect of the capsule.
Step 4: Fracture Reduction and Provisional Fixation Reduce the distal humeral fragments anatomically under direct visualization posteriorly and indirectly with fluoroscopy using the intact sigmoid notch as a template for reduction.
Step 5: Definitive Fixation Place multiple screws distally through the plates medially and laterally; each screw should be of maximal length and engage the opposite column.
Step 6: Wound Closure and Postoperative Management Remove the dressing on postoperative day two and begin full active-assisted elbow range of motion and grip-strengthening therapy program.
Results In our series of thirty-seven patients12, all fractures healed primarily with a median motion arc of 126° (range, 60° to 141°). The median triceps strength loss was 10% (range, 0% to 49%).
What to Watch For Indications
Pitfalls & Challenges
Open treatment of extra-articular and intra-articular distal humeral fractures can be effectively accomplished through an extensor mechanism-on approach.
The optimal approach for open reduction and internal fixation (ORIF) of distal humeral fractures that provides adequate visualization of the distal part of the humerus and articular surface but minimizes soft-tissue and extensor mechanism disruption is still a topic of controversy. Traditionally, these fractures have been managed operatively with various extensor-mechanism-disrupting approaches1-7, which are often associated with delayed union or nonunion of the olecranon, triceps …
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