Bicondylar Intraarticular Fractures of the Distal Humerus in Adults

Abstract

intraarticular fractures of the distal humerus, because of their rarity and often associated significant displacement, comminution, and osteopenia, present the orthopedist with a difficult injury to reliably treat successfully. As with any displaced intraarticular fracture, the principles of anatomic restoration of the articular surface, stable fixation, and early motion are the optimal treatment goals. To obtain reproducible results, an established treatment protocol is required and is described in detail here. The average excellent-togood results with surgical treatment for Type C fractures (,,T*' or "Y'* bicondylar fractures) is 75% (range, 65-100%). Complications include heterotopic ossification (4%)' infection (4%), ulnar nerve palsy (7%), failure of fixation (5%), and nonunion (2%).Bicondylar intraarticular fractures of the distal humerus are relatively rare (less than 1% of adult fractures) and can be very challenging to treat successfully. As with most difficult and problematic fractures, the literature is replete with conflicting opinions. Most would agree that an anatomic restitution of the articular surface would be optimal, but only if this can be achieved reliably, and without loss of function or complications.Recent trends support open reduction, stable internal fixation, and early postoperative ac-

The comparison of triceps-reflecting anconeus pedicle and olecranon osteotomy approaches in the treatment of intercondylar fractures of the humerus

“…[12] Restoration of elbow motion is one of the most important parameters in the treatment of intra-articular distal humerus fractures. [4][5][6][7] Athwal et al [25] compared the TRAP (n=12) and olecranon osteotomy (n=17) approach in the treatment of type C distal humeral fractures. They found no significant difference between both groups in terms of flexion-extension arc, elbow flexion, elbow extension, pronation, supination, MEPS or DASH score.…”

“…The risk of requiring subsequent hardware removal has been reported as 13% to 30%. [3][4][5][6][7][8] Tak et al [31] have used olecranon osteotomy in ninety-four patients and stated that all the unsatisfactory results (average and poor) were seen in those patients who developed complications related to the olecranon osteotomy (p=0.000, OR 103.2). In the current study, 22% of the patients had implant removal related to the symptom of implants used for olecranon osteotomy repair.…”

“…[4][5][6] To better visualize the articular surface, olecranon osteotomy, [7][8][9] Bryan-Murrey (triceps reflecting), [10] triceps splitting (Campbell), [11] and triceps-reflecting anconeus pedicle (TRAP) [12] approaches have been used.…”

The functional results of complex distal humeral fractures treated with parallel plate technique

“…Dirsek ekleminde hareket kısıtlılığı sık rastlanan bir sorundur. Heterotopik ossifikasyon ve kapsül kontraktürü genellikle bu sorunun sebebidir ve çeşitli serilerde hastaların %4-16'sının bu nedenle opere edildiği bildirilmiştir (4,22). Hastalarımızdan beşinde heterotropik ossifikasyon gelişmiş ancak bunların hiçbirinde rezeksiyona ihtiyaç duyulmamıştır.…”

“…Hastalarımızdan derin enfeksiyon gelişen debridman yapılan bir hastamız olmuştur ve bu hastanın da tip 3A açık kırığı mevcuttu. Çeşitli çalışmalarda sinir yaralanması ve avasküler nekroz komplikasyonları da bildirilmiştir (2,4,6,14,22). Ancak bizim vakalarımızda bu komplikasyonlara rastlanmamıştır.…”