Distal Humeral Fracture Fixation with an Extensor Mechanism-on Approach.

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.