- 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;
- controversies:
- total elbow replacement
- Distal humeral fractures treated with noncustom total elbow replacement. J Bone Joint Surg Am 2004;86:940-947.
- A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intra-articular distal humerus fractures
in women older than age 65. J Orthop Trauma 2003;17:473-480.
- A multicenter, prospective, randomized, controlled trial of ORIF versus TEA for displaced intra-articular distal humeral frx in elderly patients.
- Operative Technique:
- 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:
Intercondylar fractures of the humerus. An operative approach.
Mechanical failures of internal fixation in T and Y fractures of the distal humerus.
Fractures of the distal humerus.
Operative treatment of bicondylar intraarticular fractures of the distal humerus.
Surgical treatment of fractures of the capitellum in adults: a modified technique.
Internal fixation of the distal humerus: a biomechanical comparison of methods.
Fractures of the adult distal humerus. Elbow function after internal fixation.
Intraarticular fractures of the distal humerus. Surgical treatment and results.
Coronal shear fractures of the distal end of the humerus.
Multiplane fracture of the distal humerus.
Unicondylar fractures of the distal humerus: an operative approach.
Distal humeral fractures in the adult.
Biomechanical evaluation of methods of internal fixation of the distal humerus. EH Schemitsch et al. J. Orthop. Trauma. Vol 4. p 260-264.
Intraarticular fractures of the distal humerus in the adult.
Bicondylar intra-articular fractures of the distal humerus in adults. DL Helfet and GJ Schmeling. CORR. Vol 292. 1993. p26-36.
Operative treatment of type C intercondylar fractures of the distal humerus: Results after a mean follow-up of 2 years in a series of 18 patients
Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach. J Bone Joint Surg Am 2000;82:1701-1707.
(
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 anesthesiologist reverse all paralytics so that the nerve stimulator can confirm adequate function of 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;
