Jason M Erpelding1, Matthew A Mormino2, Edward V Fehringer2. 1. Medical College of Wisconsin, 8700 Watertown Plank Road, Milwaukee, WI 53226. E-mail address: jerpelding@medicine.nodak.edu. 2. Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, 981080 Nebraska Medical Center, Omaha, NE 68198.
Abstract
INTRODUCTION: Open treatment of extra-articular and intra-articular distal humeral fractures can be effectively accomplished through an extensor mechanism-on approach. STEP 1 PREOPERATIVE PLANNING: Assess all images for multiplane fracture lines involving the capitellum or trochlea. STEP 2 OPERATIVE SETUP: Verify with fluoroscopy that the patient and arm positions allow for adequate imaging of the distal part of the humerus. STEP 3 SURGICAL APPROACH: Perform medial and lateral arthrotomies posterior to the collateral ligament complexes and excise the intra-articular fat pad and posterior aspect of the capsule. STEP 4 FRACTURE REDUCTION AND PROVISIONAL FIXATION: Reduce the distal humeral fragments anatomically under direct visualization posteriorly and indirectly with fluoroscopy using the intact sigmoid notch as a template for reduction. STEP 5 DEFINITIVE FIXATION: Place multiple screws distally through the plates medially and laterally; each screw should be of maximal length and engage the opposite column. STEP 6 WOUND CLOSURE AND POSTOPERATIVE MANAGEMENT: Remove the dressing on postoperative day two and begin full active-assisted elbow range of motion and grip-strengthening therapy program. RESULTS: In our series of thirty-seven patients12, all fractures healed primarily with a median motion arc of 126° (range, 60° to 141°). The median triceps strength loss was 10% (range, 0% to 49%). WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: Open treatment of extra-articular and intra-articular distal humeral fractures can be effectively accomplished through an extensor mechanism-on approach. STEP 1 PREOPERATIVE PLANNING: Assess all images for multiplane fracture lines involving the capitellum or trochlea. STEP 2 OPERATIVE SETUP: Verify with fluoroscopy that the patient and arm positions allow for adequate imaging of the distal part of the humerus. STEP 3 SURGICAL APPROACH: Perform medial and lateral arthrotomies posterior to the collateral ligament complexes and excise the intra-articular fat pad and posterior aspect of the capsule. STEP 4 FRACTURE REDUCTION AND PROVISIONAL FIXATION: Reduce the distal humeral fragments anatomically under direct visualization posteriorly and indirectly with fluoroscopy using the intact sigmoid notch as a template for reduction. STEP 5 DEFINITIVE FIXATION: Place multiple screws distally through the plates medially and laterally; each screw should be of maximal length and engage the opposite column. STEP 6 WOUND CLOSURE AND POSTOPERATIVE MANAGEMENT: Remove the dressing on postoperative day two and begin full active-assisted elbow range of motion and grip-strengthening therapy program. RESULTS: In our series of thirty-seven patients12, all fractures healed primarily with a median motion arc of 126° (range, 60° to 141°). The median triceps strength loss was 10% (range, 0% to 49%). WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
Authors: Chad P Coles; David P Barei; Sean E Nork; Lisa A Taitsman; Douglas P Hanel; M Bradford Henley Journal: J Orthop Trauma Date: 2006-03 Impact factor: 2.512
Authors: Jason M Erpelding; Adam Mailander; Robin High; Matthew A Mormino; Edward V Fehringer Journal: J Bone Joint Surg Am Date: 2012-03-21 Impact factor: 5.284