Executive Editor: Chris Colton

Authors: Mariusz Bonczar, Daniel Rikli, David Ring

Distal humerus

back to skeleton

Glossary

Basic treatment techniques

Basic technique: Modular external fixation

Extraarticular, avulsion of lateral epicondyle

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Minimally displaced or patient not fit for surgery Basic surgical experience, no specialized skills Basic equipment only
ORIF - Screw fixation Any significant displacement. Incarceration in joint. Varus instability of elbow Some specialized surgical experience Simple surgical and imaging resources

Extraarticular, avulsion of medial epicondyle

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Minimally displaced or patient not fit for surgery Basic surgical experience, no specialized skills Basic equipment only
ORIF - Screw fixation Any significant displacement. Valgus instability of elbow. Ulnar nerve compromise Some specialized surgical experience Simple surgical and imaging resources

Extraarticular, avulsion of medial epicondyle, incarcerated

Please select a treatment option:
Treatment Indication summary Skill Equipment
ORIF - Screw fixation Surgery always indicated Highly experienced and skilled surgeon Simple surgical and imaging resources

Extraarticular, simple, oblique

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Minimally displaced or patient not fit for surgery Some specialized surgical experience Basic equipment only
External fixation Severe open fractures. Unstable fracture. Unstable patient. Usually preliminary treatment Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - Plate fixation Majority of displaced fractures. Nerve or vessel injury Highly experienced and skilled surgeon Simple surgical and imaging resources

Extraarticular, simple, transverse

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Minimally displaced or patient not fit for surgery Some specialized surgical experience Basic equipment only
External fixation Severe open fractures. Unstable fracture. Unstable patient. Usually preliminary treatment Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - Plate fixation Majority of displaced fractures. Nerve or vessel injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Extraarticular, wedge, intact or fragmentary

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Minimally displaced or patient not fit for surgery Some specialized surgical experience Basic equipment only
External fixation Severe open fractures. Unstable fracture. Unstable patient. Usually preliminary treatment Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - Plate fixation Majority of displaced fractures. Nerve or vessel injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Extraarticular, multifragmentary

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Minimally displaced or patient not fit for surgery Some specialized surgical experience Basic equipment only
External fixation Severe open fractures. Unstable fracture. Unstable patient. Usually preliminary treatment Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - Plate and screw fixation Treatment of choice for displaced fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Partial articular, lateral sagittal

Please select a treatment option:
Treatment Indication summary Skill Equipment
ORIF - Screw fixation Single fragment, low demand patient, good bone quality Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Screw and protection plate Large fragment, high demand patient Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - Plate fixation Large single fragment, high demand patient Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - Plate and screw fixation (+/- headless screws) Multifragmentary fragment +/- associated osteochondral fragment(s) Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Partial articular, medial sagittal, simple, through trochlear groove

Please select a treatment option:
Treatment Indication summary Skill Equipment
ORIF - Plate and screw fixation Most simple fractures through the trochlear groove Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Partial articular, medial sagittal, simple, through medial articular surface

Please select a treatment option:
Treatment Indication summary Skill Equipment
ORIF - Screw fixation Surgeon’s preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Partial articular, medial sagittal, fragmentary, transtrochlear

Please select a treatment option:
Treatment Indication summary Skill Equipment
ORIF - Plate and screw fixation All fragmentary transtrochlear fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Partial articular, frontal/coronal, capitellum

Please select a treatment option:
Treatment Indication summary Skill Equipment
ORIF - Headless screw fixation Surgeon’s preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Partial articular, frontal/coronal, trochlea

Please select a treatment option:
Treatment Indication summary Skill Equipment
ORIF - Headless screw fixation All frontal fractures of the trochlea Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Partial articular, frontal/coronal, capitellum and trochlea

Please select a treatment option:
Treatment Indication summary Skill Equipment
ORIF - Screw fixation +/- protection plate All frontal fractures of capitellum and trochlea Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Complete articular, simple articular, simple metaphyseal

Please select a treatment option:
Treatment Indication summary Skill Equipment
ORIF - Perpendicular plating Surgeon’s preference - biomechanically more stable Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - Parallel plating Surgeon’s preference Highly experienced and skilled surgeon Simple surgical and imaging resources

Complete articular, simple articular, fragmentary metaphyseal

Please select a treatment option:
Treatment Indication summary Skill Equipment
ORIF - Perpendicular plating Surgeon’s preference - biomechanically more stable Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Parallel plating Surgeon’s preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Complete articular, multifragmentary articular

Please select a treatment option:
Treatment Indication summary Skill Equipment
ORIF - Perpendicular plating Surgeon’s preference. Choice determined by fracture anatomy Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Parallel plating Surgeon’s preference. Choice determined by fracture anatomy Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Special considerations

Principles of management of open fractures
Infection
Compartment syndrome
*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