Executive Editor: Fergal Monsell

General Editor: Chris Colton

Authors: Andrew Howard, Theddy Slongo

Pediatric distal humerus

Overview

Distal humeral anatomy i

An understanding of the anatomy, biomechanics and growth plate patterns of the distal humerus is vital to the rational consideration of fracture care in children.

Lateral approach i

The main indication for a lateral approach in the distal humerus are:

  • Displaced lateral condylar fractures (13-E/3.1 and 13-E/4.1)
  • Displaced capitellar fractures (13-E/8.1)
  • Displaced, unstable avulsion of the lateral collateral ligament (13-E/7L)
  • Irreducible supracondylar fractures (13-M/3)

Medial approach i

The main indications for a medial approach to the distal humerus are:

  • Open fixation of medial epicondylar fractures
  • Visualization of the medial epicondyle for safe K-wire insertion when using bilateral crossed K-wiring
  • Ulnar nerve exploration

Note: The medial approach, including opening of the joint, is not an ideal procedure for supracondylar fractures.

Posterior approach i

The main indications for a posterior approach in the distal humerus are:

  • Y-fractures or T-fractures (13-E/4.2)

Bear in mind that use of posterior approach for extension type supracondylar fractures, compromises the tension band effect of the posterior periosteum.

Anterior approach i

The main indications for an anterior approach to the distal humerus are:

  • Vessel exploration
  • Nerve exploration

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v1.0 2016-12-01