Skip to main content

Advertisement

Log in

Open reduction and bi-columnar internal fixation of intra-articular distal humerus fractures through a combined medial and lateral approach

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this retrospective study was to investigate the suitability of bi-columnar internal fixation through a combined medial and lateral approach for the treatment of intra-articular distal humerus fractures.

Methods

Nineteen cases of intra-articular distal humerus fractures were treated with open reduction and bi-columnar internal fixation through a combined medial and lateral approach. The reduction in the articular surface and functional recovery of the affected elbows was assessed at an average follow-up of 15.8 ± 7.9 (7–43) months.

Results

The gap in the main articular fragments was less than 1 mm in 16 cases, while a gap of more than 1 mm and less than 2 mm was identified in 2 cases and of 3.7 mm in one case. All the fractures were united. At the latest follow-up, the mean flexion–extension of the elbows was 113.4° ± 20.7°, while the pronation–supination of the forearms was 158.3° ± 8.5°, and the mean Mayo Elbow Performance Index was 93.7 ± 9.1 points, leading to 13 excellent outcomes, and 6 with good results.

Conclusions

Intra-articular fractures of the distal humerus can be effectively treated by open reduction and internal fixation through a combined medial and lateral approach at the elbow.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Nauth A, McKee MD, Ristevski B, Hall J, Schemitsch EH (2011) Distal humeral fractures in adults. J Bone Joint Surg Am 93(7):686–700. doi:10.2106/JBJS.J.00845

    Article  PubMed  Google Scholar 

  2. McKee MD, Wilson TL, Winston L, Schemitsch EH, Richards RR (2000) Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach. J Bone Joint Surg Am 82-A(12):1701–1707

    CAS  PubMed  Google Scholar 

  3. Schildhauer TA, Nork SE, Mills WJ, Henley MB (2003) Extensor mechanism-sparing paratricipital posterior approach to the distal humerus. J Orthop Trauma 17(5):374–378

    Article  PubMed  Google Scholar 

  4. Ali AM, Hassanin EY, El-Ganainy AE, Abd-Elmola T (2008) Management of intercondylar fractures of the humerus using the extensor mechanism-sparing paratricipital posterior approach. Acta Orthop Belg 74(6):747–752

    PubMed  Google Scholar 

  5. O’Driscoll SW (2000) The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonunions. Orthop Clin North Am 31(1):91–101

    Article  PubMed  Google Scholar 

  6. Wong AS, Baratz ME (2009) Elbow fractures: distal humerus. J Hand Surg Am 34(1):176–190. doi:10.1016/j.jhsa.2008.10.023

    Article  PubMed  Google Scholar 

  7. Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 58(4):453–458

    CAS  PubMed  Google Scholar 

  8. Müller ME, Nazarian S, Koch P, Schatzker J (1990) The comprehensive classification of fractures of long bones. Springer, New York

  9. An ZBZ, Xiaojian He, Dong Chen, Lei Wang (2009) The triple-window approach, without olecranon osteotomy or radial nerve exposure, to intra-articular distal humeral fractures extending into the humeral shaft. Inj Extra 40:6. doi:10.1016/j.injury.2008.11.020

    Article  Google Scholar 

  10. Caja VL, Moroni A, Vendemia V, Sabato C, Zinghi G (1994) Surgical treatment of bicondylar fractures of the distal humerus. Injury 25(7):433–438

    Article  CAS  PubMed  Google Scholar 

  11. Gill DR, Morrey BF (1998) The Coonrad–Morrey total elbow arthroplasty in patients who have rheumatoid arthritis. A ten to fifteen-year follow-up study. J Bone Joint Surg Am 80(9):1327–1335

    CAS  PubMed  Google Scholar 

  12. Dakoure PW, Ndiaye A, Ndoye JM, Sane AD, Niane MM, Seye SI, Dia A (2007) Posterior surgical approaches to the elbow: a simple method of comparison of the articular exposure. Surg Radiol Anat 29(8):671–674. doi:10.1007/s00276-007-0263-8

    Article  CAS  PubMed  Google Scholar 

  13. Wilkinson JM, Stanley D (2001) Posterior surgical approaches to the elbow: a comparative anatomic study. J Should Elb Surg 10(4):380–382. doi:10.1067/mse.2001.116517

    Article  CAS  Google Scholar 

  14. Coles CP, Barei DP, Nork SE, Taitsman LA, Hanel DP, Henley MB (2006) The olecranon osteotomy: a six-year experience in the treatment of intraarticular fractures of the distal humerus. J Orthop Trauma 20(3):164–171

    PubMed  Google Scholar 

  15. Schmidt-Horlohe K, Wilde P, Bonk A, Becker L, Hoffmann R (2011) One-third tubular-hook-plate osteosynthesis for olecranon osteotomies in distal humerus type-C fractures: a preliminary report of results and complications. Injury. doi:10.1016/j.injury.2011.06.418

  16. Sane AD, Dakoure PW, Dieme CB, Kinkpe CV, Dansokho AV, Ndiaye A, Seye SI (2009) Olecranon osteotomy in the treatment of distal humeral fractures in adults: anatomical and functional evaluation of the elbow in 14 cases. Chir Main 28(2):93–98. doi:10.1016/j.main.2008.12.004

    Article  CAS  PubMed  Google Scholar 

  17. Gofton WT, Macdermid JC, Patterson SD, Faber KJ, King GJ (2003) Functional outcome of AO type C distal humeral fractures. J Hand Surg Am 28(2):294–308. doi:10.1053/jhsu.2003.50038

    Article  PubMed  Google Scholar 

  18. Ring D, Gulotta L, Chin K, Jupiter JB (2004) Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus. J Orthop Trauma 18(7):446–449

    Article  PubMed  Google Scholar 

  19. Berry DJ, Steinmann SP, Tornetta P (2007) Surgical exposures of the elbow. In: Adult reconstruction. Lippincott Williams & Wilkins, Philadelphia, pp 398–399

  20. Chen RC, Harris DJ, Leduc S, Borrelli JJ Jr, Tornetta P 3rd, Ricci WM (2010) Is ulnar nerve transposition beneficial during open reduction internal fixation of distal humerus fractures? J Orthop Trauma 24(7):391–394. doi:10.1097/BOT.0b013e3181c99246

    Article  PubMed  Google Scholar 

  21. Reising K, Hauschild O, Strohm PC, Suedkamp NP (2009) Stabilisation of articular fractures of the distal humerus: early experience with a novel perpendicular plate system. Injury 40(6):611–617. doi:10.1016/j.injury.2008.12.018

    Article  CAS  PubMed  Google Scholar 

  22. Tyllianakis M, Panagopoulos A, Papadopoulos AX, Kaisidis A, Zouboulis P (2004) Functional evaluation of comminuted intra-articular fractures of the distal humerus (AO type C): long term results in twenty-six patients. Acta Orthop Belg 70(2):123–130

    PubMed  Google Scholar 

  23. Chen G, Liao Q, Luo W, Li K, Zhao Y, Zhong D (2011) Triceps-sparing versus olecranon osteotomy for ORIF: analysis of 67 cases of intercondylar fractures of the distal humerus. Injury 42(4):366–370. doi:10.1016/j.injury.2010.09.004

    Article  PubMed  Google Scholar 

  24. Lakhey S, Sharma S, Pradhan RL, Pandey BK, Manandhar RR, Rijal KP (2010) Osteosynthesis of intercondylar humerus fracture using Bryan and Morrey approach. Kathmandu Univ Med J (KUMJ) 8(30):154–157

    CAS  Google Scholar 

  25. Pankaj A, Mallinath G, Malhotra R, Bhan S (2007) Surgical management of intercondylar fractures of the humerus using triceps reflecting anconeus pedicle (TRAP) approach. Indian J Orthop 41(3):219–223. doi:10.4103/0019-5413.33686

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the fund of the National Natural Science Foundation of China (81171704).

Conflict of interest

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Zhiquan An.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Xie, X., Qin, H., Shen, L. et al. Open reduction and bi-columnar internal fixation of intra-articular distal humerus fractures through a combined medial and lateral approach. Eur J Orthop Surg Traumatol 24, 1115–1122 (2014). https://doi.org/10.1007/s00590-013-1302-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-013-1302-2

Keywords

Navigation