Rate of union has been reported to range from 91% to 96%.
JBJS Essential Surgical Techniques accepts submissions from all areas of orthopaedics.
Initiate aggressive physical therapy as soon as fracture stability allows.
Latest Surgical Technique
- Arvind von Keudell , MD
- Amin Mohamadi , MD, MPH
- Claudia A. Bargon , BSc
- Jesse B. Jupiter , MD
- Arvind von Keudell, MD1,*,a,
- Amin Mohamadi, MD, MPH2,*,b,
- Claudia A. Bargon, BSc1,c and
- Jesse B. Jupiter, MD1,3,d
- 1Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
- 2Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- 3Harvard Medical School, Boston, Massachusetts
- ↵aE-mail address for A. von Keudell:
- ↵bE-mail address for A. Mohamadi:
- ↵cE-mail address for C.A. Bargon:
- ↵dE-mail address for J.B. Jupiter:
↵* Arvind von Keudell, MD, and Amin Mohamadi, MD, MPH, contributed equally to the writing of this article
Introduction Unicondylar distal humeral fractures are uncommon, partially intra-articular fractures (OTA/AO type B1) that are among the most complex fractures to treat1,2; however, most displaced distal humeral fractures, including lateral unicondylar distal humeral fractures2-5, can be effectively managed with open reduction and internal fixation.
Indications & Contraindications
Step 1: Preparation of the Operating Room and the Patient Perform sterile preparation, have the patient brought into the operating room, induce anesthesia, and place the patient in the lateral decubitus or supine position before sterile draping.
Step 2: Approach to the Fracture Make a lateral incision, expose the lateral distal part of the humerus, identify the ulnar nerve if necessary, visualize the fracture fragments, and debride the fracture site.
Step 3: Reduction of the Fracture Reduce the fracture and fix it temporarily.
Step 4: Plate Fixation of the Fracture Determine the plate length; position the plate posterolaterally, posteriorly, or laterally; insert screws; remove provisional Kirschner wires; and obtain intraoperative images.
Step 5: Final Radiographic Imaging Make anteroposterior and lateral radiographic images to confirm reduction and adequate anatomic alignment of the elbow and the position of the hardware.
Step 6: Closure of the Wound Deflate the tourniquet, irrigate the wound, and apply postoperative dressings.
Results The detailed outcome for a cohort of 24 patients who underwent this procedure has been reported elsewhere6.
Pitfalls & Challenges
Unicondylar distal humeral fractures are uncommon, partially intra-articular fractures (OTA/AO type B1) that are among the most complex fractures to treat1,2; however, most displaced distal humeral fractures, including lateral unicondylar distal humeral fractures2-5, can be effectively managed with open reduction and …
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