Intercondylar fractures of the distal humerus in adults: a critical analysis of 55 cases.

Intercondylar fractures of the distal humerus in adults are difficult management problems on account of the complex anatomy of the elbow, small sized fracture fragments and the limited amount of sub-chondral bone, which is often osteopenic. The results of managing these fractures non-operatively are compromised by the failure to get anatomical reduction and early mobilization. This often results in a painful stiff elbow and/or pseudarthrosis, thereby making an operative approach for these fractures, desirable. Fifty-five such fractures, operated on by the author during the last 9 years, were reviewed. All the fractures were managed by open reduction and internal fixation followed by early mobilization. The outcome in 51 of these cases was graded as excellent or good using the evaluation criteria of Aitken and Rorabeck. Thirty-three of these cases achieved a range of flexion of more than 130 degrees. There was minimal incidence of complications like ulnar nerve neuropraxia or heterotopic bone formation. Anterior transposition of the ulnar nerve was performed in only one of the patients. Dorsal application of both the plates instead of the commonly advocated supracondylar crest placement resulted in a stable configuration requiring less extensive dissection and retraction of the ulnar nerve and resulting in a low incidence of complications.