Surgical treatment of bicondylar fractures of the distal humerus.

Between 1981 and 1989 22 bicondylar fractures of the distal humerus were operated on. Fractures were classified according to the AO system. Fixation consisted of medial and lateral plates combined to articular screws in 14 cases, one articular screw associated to one medial screw and a lateral plate in four cases, three lag screws in three cases, and in one case the articular screw was associated to one medial screw and one 'Y' plate. Osteotomy of the olecranon was fixed by one intramedullary screw and one wire in 15 cases, other simpler methods (wire or screw alone) were used in seven cases. A scoring system that included pain, range of motion, radiological results and postoperative activity level, was developed to study the results. Two fractures went to nonunion. Results were quoted as excellent in six cases, good in five cases, fair in eight patients and poor in three cases. Younger patients achieved a better range of motion (P = 0.039) and better functional level (P = 0.015), and differences in radiological score (P = 0.029), activity level score (P = 0.048) and total score (P = 0.0031) were observed depending on the anatomical fracture type.