Adult Humeral Inter-condylar Fractures - Wheeless' Textbook of Orthopaedics

- Fractures Subtypes:
- capitellar and coronal shear frx
- distal humeral frx:
- lateral condyle frx:
- medial condyle frx:
- Muller's Classfication:
- type A: extra-articular fracture;
- type B: uni-condylar fracture;
- type C: bi-condylar fracture;

- Operative Technique: (Synthes Distal Humerus Products)
- preparation & positioning:

- surgical exposure:
- posterior approach;
- midline incision is used, skirting radial side of olecranon;
- always modify incision to incorporate any previous incision;
- olecranon osteotomy:
- is generally reserved for intra-articular fractures;
- alternative approaches:
- posterolateral (kocher) approach
- lateral approach:
- medial approach:
- generally the ulnar nerve and/or radial nerve need to be exposed prior to hardware insertion;
- this being the case, ask the anesthesiologist to hold paralytics at the beginning of the case and avoid
using the tourniquet so that a nerve stimulator can be used;
- once these nerves have been identified, the patient should be paralyzed inorder to facilitate the reduction;
- restoration of fracture anatomy:
- plate application:
- assessment:
- take the elbow thru a range of motion;
- loss of motion may indicate that screws have crossed olecranon fossa;
- ensure that the fixation is relatively stable, otherwise additional fixation is required;
- have the anesthesiologist reverse all paralytics so that the nerve stimulator can confirm adequate function of the ulnar and/or radial nerves;
- ulnar nerve in condylar fractures:
- note that a plate or lag screw placed over the distal-medial edge of the condyle will encroach on the cubital tunnel and may irritate the ulnar nerve;
- in these patients, anterior transposition may indicated;

- Complications:
- elbow flexion contracture:
- non union:
Salvage of non-union of supracondylar fracture of the humerus by total elbow arthroplasty.
Non-union of fractures of the distal end of the humerus.

Examples: