These fractures are often associated with impaction of the posterior part of the lateral column, and/or the posterior trochlea.
Nonoperative treatment is not indicated for intraarticular fractures of the distal humerus, unless there is a general contraindication to surgery.
There is great variation between the fracture configurations within this classification group. Each fixation has to be individualized; this requires sophisticated imaging, meticulous preoperative planning and a high level of surgical experience and skill. Ideally these fractures should be referred to a unit with such special resources.
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 - Screw fixation +/- protection plate|
|All frontal fractures of capitellum and trochlea|
For most of these fractures, open reduction and screw fixation with or without protection plate are the preferred treatment.
Each fixation has to be individualized; this requires sophisticated imaging, meticulous preoperative planning and a high level of surgical experience and skill. Ideally these fractures should be referred to a unit with such special resources.
Note: in cases where there are larger, partially nonarticular fragments, a lateral plate can be applied.
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
- Requires very high level of surgical expertise
- Requirement for anesthesia
|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|