Nonoperative treatment is not indicated for intraarticular fractures of the distal humerus, unless there is a general contraindication to surgery.
All adult articular fractures of the distal humerus require open anatomical reduction and stable fixation.
Because adult elbows are notorious for becoming stiff after injury, the goal of operative treatment is anatomical reduction and stable fixation, especially of any joint fragments, so that active motion can be started within a few days of surgery.
Pediatric fractures are considered in Pediatric trauma of Surgery Reference.
|ORIF - Plate and screw fixation|
|All fragmentary transtrochlear fractures|
The fixation principles involved here include interfragmentary lag screw fixation combined with buttress plating; depending on the fracture configuration some of the lag screws may be independent and some inserted through the plate. This treatment is applied in all these fractures.
Contraindications for surgery
- Noncompliant patient
- Unacceptable surgical risk
- Extreme osteoporosis
Advantages of open reduction and internal fixation
- Anatomical reduction
- Articular congruity
- Early functional aftertreatment
- Reduced risk of degenerate joint disease
Disadvantages of open reduction and internal fixation
- Risk of infection
- Requirement for anesthesia
- Requires very high level of surgical expertise
- If a transolecranon approach is chosen, osteotomy fixation wires can cause irritation and often need later removal.
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|