Open Reduction and Internal Fixation for Lateral Unicondylar Distal Humeral Fractures.

INTRODUCTION: Unicondylar distal humeral fractures are uncommon, partially intra-articular fractures (OTA/AO type B1) that are among the most complex fractures to treat1,2; however, most displaced distal humeral fractures, including lateral unicondylar distal humeral fractures2-5, can be effectively managed with open reduction and internal fixation. STEP 1 PREPARATION OF THE OPERATING ROOM AND THE PATIENT: Perform sterile preparation, have the patient brought into the operating room, induce anesthesia, and place the patient in the lateral decubitus or supine position before sterile draping. STEP 2 APPROACH TO THE FRACTURE: Make a lateral incision, expose the lateral distal part of the humerus, identify the ulnar nerve if necessary, visualize the fracture fragments, and debride the fracture site. STEP 3 REDUCTION OF THE FRACTURE: Reduce the fracture and fix it temporarily. STEP 4 PLATE FIXATION OF THE FRACTURE: Determine the plate length; position the plate posterolaterally, posteriorly, or laterally; insert screws; remove provisional Kirschner wires; and obtain intraoperative images. STEP 5 FINAL RADIOGRAPHIC IMAGING: Make anteroposterior and lateral radiographic images to confirm reduction and adequate anatomic alignment of the elbow and the position of the hardware. STEP 6 CLOSURE OF THE WOUND: Deflate the tourniquet, irrigate the wound, and apply postoperative dressings.
RESULTS: The detailed outcome for a cohort of 24 patients who underwent this procedure has been reported elsewhere6.