Surgical fixation of intra-articular fractures of the distal humerus in adults
Introduction
Intra-articular fractures of the distal humerus are not common and remain one of the most difficult fractures to treat. Non-operative treatment traditionally results in dismal functional outcome with disabling limitations of elbow motion. However, over the past two decades, operative reduction and internal fixation has become more accepted as a means to achieve anatomical restoration of the articular surface and facilitate early mobilisation. Nevertheless, many authors differ in their opinions with regard to the extent and type of internal fixation, as well as the duration of post-operative immobilisation. The improved AO/ASIF techniques for the fixation of small articular fragments has made operative results more predictable and more recently, dual plate fixation in two planes has become the standard of treatment.1., 2. Based on the AO/ASIF classification of this fracture, we retrospectively reviewed our results for 15 patients operated over a period of 2 years.
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Material and methods
We treated 15 adult patients with intra-articular distal humerus fractures between 1998 and 2000. All the fractures were classified using the AO/ASIF classification. Twelve patients had complete articular grade C fractures (4 type C1; 4 type C2; and 4 type C3 fractures), and the remaining 3 patients each had a type B1, B2, and B3 partial articular fracture. All patients were identified from the hospital computer database and a review of their medical notes was performed.
The mean age of our
Results
We report the overall results of all 15 patients with the AO/ASIF types B, partial articular; and C, complete articular fractures (Table 1).
Complications
In our series of 15 patients, complications included two post-operative ulnar nerve neuropraxia (Table 3), one wound infection (patient 9), and one fracture fibrous non-union (patient 10). All nerve injuries recovered between 2 and 9 months after surgery.
Discussion
Numerous operative approaches have been described for the distal humerus.3 The posterior approach was used in all our patients. Amongst these, the “triceps-lift” was used in six patients, five of whom have type C fractures. Alonso-Llames in 1972 described this triceps preserving “bilaterotricipital” approach to the elbow.4 The distal humerus is approached from the medial and lateral sides of the long head of triceps (i.e. between the medial and long heads, and between the long and lateral heads
Conclusions
We reviewed 15 patients with intra-articular distal humerus fractures treated surgically, of which three required subsequent re-fixation, and four underwent joint mobilisation surgery. The mean arc of flexion of our patients with type C fractures following primary fixation is 92.5° (45–140°), whilst the type B group have a mean arc of 110° (60–145°). The sub-group of type C patients without revision surgery had a mean flexion arc of 110.7° (95–140°), with 100% Good to Excellent scores. Our
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