Executive Editor: Chris Colton

Authors: Mariusz Bonczar, Daniel Rikli, David Ring

Distal humerus - Partial articular, frontal/coronal, trochlea

back to skeleton

Glossary

General considerations

Frontal trochlear fractures often have articular fragmentation. 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 - Headless screw fixation
Indication summary Skill Equipment
All frontal fractures of the trochlea Highly experienced and skilled surgeon Full specialized surgical and imaging resources

This treatment is used for 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
  • Requires very high level of surgical expertise
  • Requirement for anesthesia
  • Cost
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2007-06-21