Surgical Elbow Dislocation Approach to the Distal Humerus for Apparent Capitellar and Lateral Condyle Fractures in Adults

Abstract

Objectives: Access to fractures of the distal humeral capitellum, trochlea, and lateral condyle is difficult through traditional approaches due to limited anterior articular exposure for direct reduction and fixation. The purpose of this study is to evaluate the relative articular exposure of a surgical dislocation (SD) approach to the distal humerus compared with olecranon osteotomy (OO). Methods: Eight paired elbows from 4 cadavers underwent either SD or OO approach. Methylene blue staining demarcated visualized articular surface before disarticulation of the elbows. The main outcome measures were average visualized total distal humeral articular surface and anterior and posterior surface, and capitellar surface relative to the total surfaces was compared for each surgical approach using unpaired parametric t-tests. Results: Intraclass correlation between raters was 0.995. The median exposed articular surface for SD and OO approaches was 90.0% and 62.8%, respectively. The overall exposure was significantly greater for the dislocation technique (P = 0.0003). With respect to specific regions of the distal humeral articular surface, SD allowed significantly greater visualization of the anterior surface (95.9% vs. 48.9%, P < 0.0001) and capitellum (100% vs. 40.4%, P < 0.0001). Conclusion: The surgical elbow dislocation approach to the distal humerus permits near total exposure of the anterior articular surface and the entire capitellum. Our data support this approach for anterior articular fractures of the distal humerus, to include those fractures that extend to the medial surface of the trochlea.

The recovery of upper limb function and postoperative pain in children with lateral humeral condyle fractures were examined retrospectively in relation to the effects of brachial plexus block given in conjunction with general anesthesia

“…Immature bone growth, excessive activity, and indirect trauma in children are the most prevalent causes of lateral condylar fractures of the humerus, a common orthopedic illness in children. The main clinical manifestations include swelling, pain and dyskinesia at the lateral elbow joint, as well as tenderness at the lateral condyle of humerus [15]. The early swelling of the fracture site in this disease will cover the fracture symptoms, causing misdiagnosis and missed diagnosis, and then the continuous injury of blood vessels at the fracture end will lead to elbow deformity, bone nonunion, growth disorder, and even bone necrosis, affecting the quality of life in the future [16].…”

Open Reduction and Internal Fixation of a Type IV Capitellum Fracture Through a Transolecranon Tunnel

“…Athwal et al 13 described an olecranon osteotomy for fixation of the capitellum, but their combined approach does not necessarily increase exposure of the anterior and medial aspects of the capitellum and trochlea. Hoyt et al 14 described a lateral epicondyle osteotomy with a surgical dislocation of the elbow, which they reported provides nearly full exposure to the anterior articular surface. While osteotomies may provide excellent exposure, our approach avoids the potential complications associated with an osteotomy, such as nonunion of the osteotomy site, which would potentially lead to instability.…”

Comparison of the Posterior-anterior Approach and Lateral-medial Approach for Complex AO/OTA Type C Intra-articular Fractures of Distal Humerus

“…Despite the fact that radial nerve lesions have been reported in association with the approach, we recommend the use of a wide-blade separator to retract the mobile wad of Henry laterally along with the radial nerve [23], thus minimizing the possible insult to the nerve. Additionally, the anterior approach, which passes through the interval between the brachioradialis and the biceps or the biceps and the medial brachial neurovascular bundle, can avoid releasing the LUCL in combination with the olecranon osteotomy [24] or the lateral approach [9,25] in situations necessitating anterior exposure, such as a coronal capitellum or trochlear fracture. Because the anterior auxiliary approach combined with the olecranon osteotomy approach can expand the exposure area, it can further assist in the reduction and xation of the coronal fracture from the front, especially when the patient was positioned supine with the elbow in full extension.…”