Intraarticular fractures of the distal humerus. Surgical treatment and results.

In a 12-year period, 104 patients with intraarticular fractures of the distal humerus received surgical treatment. Based on the Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) classification, there were 40 monocondylar fractures, 46 bicondylar fractures, and 18 fractures of the ulnar epicondyle with the fragment dislocated in the elbow joint. In children almost all fixations were done with Kirschner wires. The adult fractures were stabilized according to the recommendations of the AO/ASIF, i.e., monocondylar fractures by screws and/or single-plate fixation and bicondylar fractures by screws and dual-plate fixation, preferably with reconstruction plates. Comminuted fractures required an additional osteotomy of the olecranon. Except for children, the essential feature of postoperative management was early functional treatment by continuous passive motion. Eighty-eight patients (84.6%) were followed with an average follow-up time of 4.4 years. The results were evaluated for range of motion, pain, working capacity, neural and vascular impairment, valgus/varus deformity, and subjective judgment. The long-term outcome of almost 81% good and very good results suggests that operative treatment can be valuable when indications, anatomic surgical reconstruction, and postoperative care are performed correctly.