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Original Article
- Combined Anterolateral and Lateral Approaches in Treatment of Extra-articular Fracture of the Distal Humerus
- Dae Gyu Kwon, M.D., Kyoung Ho Moon, M.D., Ph.D., Suk In Na, M.D., Byung Ki Shin, M.D., Tong Joo Lee, M.D., Ph.D.
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Journal of the Korean Fracture Society 2012;25(3):185-190.
DOI: https://doi.org/10.12671/jkfs.2012.25.3.185
Published online: July 16, 2012
Department of Orthopedic Surgery, Inha University School of Medicine, Incheon, Korea.
- Address reprint requests to: Tong Joo Lee, M.D., Ph.D. Department of Orthopedic Surgery, Inha University Hospital, 27, Inhang-ro, Jung-gu, Incheon 400-103, Korea. Tel: 82-32-890-3043, Fax: 82-32-890-3047, tjlee@inha.ac.kr
• Received: March 23, 2012 • Revised: April 22, 2012 • Accepted: May 9, 2012
Copyright © 2012 The Korean Fracture Society
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Abstract
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Purpose
- The purpose of this study was to analyze the clinical effectiveness of open reduction in the treatment of distal humeral fracture using a newly designed combined approach of anterolateral and lateral approaches to protect the radial nerve.
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Materials and Methods
- We investigated 24 consecutive cases of distal humeral fracture who received open reduction and internal fixation with a plate and screws with a minimum follow-up period of 1 year. We analyzed the patients' age, sex, fracture pattern, timing of the union, range of motion of the elbow joint, and complications. The Mayo elbow performance index (MEPI) was employed for the assessment of elbow joint function.
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Results
- Clinical union was observed at 10.8 weeks (6~20 weeks) on average. Pre-operatively, there were 3 cases of incomplete radial nerve palsy. All of the cases recovered, and there was no additional radial nerve palsy due to surgery. According to the MEPI, 13 cases were "excellent" and 10 cases were "good" or better, comprising 95.83% of the cases. The range of motion at the elbow was 5.5 degrees (0~15 degrees) of extension, and 131.5 degrees (120~145 degrees) of flexion, suggesting no functional disability. The duration of return to work was 11.2 weeks (5~32 weeks) on average. There were no nonunion, malunion, or infection complications.
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Conclusion
- The combined anterolateral and lateral approach we designed is a clinically effective approach due to facilitation of protection of the radial nerve and attainment of adequate fixation space.
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REFERENCES
Fig. 1Cross-sectional image of combined anterolateral and lateral approach. Level 1: Anterolateral approach of proximal humerus: Surgical dissection was made through the midportion of the brachialis muscle. Note the radial nerve between the brachialis muscle and brachioradialis muscle in cross section C. Level 2: Anterolateral approach of midshaft of the humerus. Level 3: Lateral approach of the distal humeral shaft: Surgical dissection is made between the triceps muscle and lateral intermuscular septum. B: Brachialis muscle, Bc: Biceps brachii muscle, Br: Brachioradialis muscle, Tc: Triceps brachii muscle.
Fig. 3
A 21-year-old man sustained the fracture in an accident.
(A) An initial radiograph shows a spiral fracture of the distal humerus.
(B) A radiograph after operation shows anatomical reduction and alignment by open reduction and internal fixation with a plate and lag screw.
(C) Follow-up radiography 1 year after operation shows good bony union of the fracture without complications.
Figure & Data
REFERENCES
Citations
Citations to this article as recorded by 
- Posterior Dual Plating for Distal Shaft Fractures of the Humerus
Chul-Hyun Cho, Kwang-Yeung Jeong, Beom-Soo Kim
Journal of the Korean Fracture Society.2017; 30(3): 117. CrossRef - Modified Combined Approach for Distal Humerus Shaft Fracture: Anterolateral and Lateral Bimodal Approach
Tong Joo Lee, Dae Gyu Kwon, Suk In Na, Seung Do Cha
Clinics in Orthopedic Surgery.2013; 5(3): 209. CrossRef
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Fig. 1
Cross-sectional image of combined anterolateral and lateral approach. Level 1: Anterolateral approach of proximal humerus: Surgical dissection was made through the midportion of the brachialis muscle. Note the radial nerve between the brachialis muscle and brachioradialis muscle in cross section C. Level 2: Anterolateral approach of midshaft of the humerus. Level 3: Lateral approach of the distal humeral shaft: Surgical dissection is made between the triceps muscle and lateral intermuscular septum. B: Brachialis muscle, Bc: Biceps brachii muscle, Br: Brachioradialis muscle, Tc: Triceps brachii muscle.
Fig. 2
A ten-hole plate bending with the contour of the distal humeral shaft.
Fig. 3
A 21-year-old man sustained the fracture in an accident.
(A) An initial radiograph shows a spiral fracture of the distal humerus.
(B) A radiograph after operation shows anatomical reduction and alignment by open reduction and internal fixation with a plate and lag screw.
(C) Follow-up radiography 1 year after operation shows good bony union of the fracture without complications.
Fig. 1
Fig. 2
Fig. 3
Combined Anterolateral and Lateral Approaches in Treatment of Extra-articular Fracture of the Distal Humerus
Patient demographic data
Values are presented as number or range.
Result of combined approach
MEPI: Mayo elbow performance index.
Table 1
Patient demographic data
Values are presented as number or range.
Table 2
Result of combined approach
MEPI: Mayo elbow performance index.
