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Distal Humerus Fracture: How to Choose the Approach, Implant, Fixation and Rehabilitation

Article information

J Musculoskelet Trauma. 2019;32(1):72-81
Publication date (electronic) : 2019 January 25
doi : https://doi.org/10.12671/jkfs.2019.32.1.72
Min Ho Lee, M.D.orcid_icon, Young Ho Lee, M.D., Ph.D.orcid_icon
Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea.
Correspondence to: Young Ho Lee, M.D., Ph.D. Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-2072-0819, Fax: +82-2-740-2718, orthoyhl@snu.ac.kr
Received 2018 December 02; Revised 2018 December 21; Accepted 2018 December 28.

Abstract

Distal humerus fractures require stable fixation and early joint motion, similar to other intra-articular fractures, but are difficult to treat adequately because of the anatomical complexity, severe comminution, and accompanying osteoporosis. In most cases, surgical treatment is performed using two supporting plates. Plate fixation can be divided into right angle plate fixation and parallel plate fixation. In addition, depending on the type of fracture, surgical procedures can be performed differently, and autologous bone grafting can be required in the case of severe bone loss. The elbow joint is vulnerable to stiffness, so it is important to start joint movement early after surgery. Postoperative complications, such as nonunion, ulnar nerve compression, and heterotopic ossification, can occur. Therefore, accurate and rigid fixation and meticulous manipulation of soft tissues are required during surgery.

Keywords: Elbow joint; Ulnar nerve; Heterotopic ossification

Notes

Financial support

None.

Conflict of interests

None.

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Copyright © 2019 The Korean Fracture Society. All rights reserved.
The Korean Fracture Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Fig. 1

Fig. 1

Tension band wiring with ring pin. (A) Ring pin is inserted to olecranon using snapper. (B) Fracture site is compressed with 8-figure tension band wire.

Fig. 2

Fig. 2

Double plating of distal humerus fracture. (A, B) Preoperative X-ray. (C, D) Double plating at medial and lateral column. (E, F) Postoperative X-ray.

Fig. 3

Fig. 3

Ulnar nerve anterior transposition. (A, B) Transposed ulnar nerve is stabilized with new tunnel made of medial intermuscular septum.

Fig. 4

Fig. 4

Type 1 fracture. (A) Preoperative X-ray showed medial side large fracture fragment. (B, C) Three-dimensional computed tomography. (D) Large fragment was fixed with interfragmentary screw. (E, F) Three years after operation, range of motion is nearly normal.

Fig. 5

Fig. 5

Type 2 fracture. (A, B) Preoperative X-ray showed severe metaphyseal comminution. (C, D) Three-dimensional computed tomography. (E) Fracture was fixed by bridging plate. (F, G) Two years after operation, range of motion is nearly normal.

Fig. 6

Fig. 6

Type 3 fracture. (A) Multiple comminuted articular bony fragment was reduced and fixed with K-wire. (B) Plate and screw was substituted by K-wire. (C–E) Postoperative X-ray showed stable reduction and normal range of motion.

Fig. 7

Fig. 7

Type 4 fracture. (A, B) Preoperative X-ray showed small metaphyseal bony fragment. (C, D) Three-dimensional computed tomography. (E, F) Small bony fragment was fixed with miniplate for simplifying fracture pattern, then reduced other fragment.

Fig. 8

Fig. 8

Rehabilitation after operation. (A) Active elbow flexion. (B) Active assisted elbow flexion. (C) Active elbow extension. (D) Active assisted elbow extension.