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

Surgical procedures sorted by fracture type

Use this menu to jump directly into a specific classification (optional):
A1.1 A1.2 A1.3 A2.1/2 A2.3 A3.1/2 A3.3 B1 B2.1 B2.2 B2.3 B3.1 B3.2 B3.3 C1 C2 C3
A1.1

Extraarticular apophyseal avulsion fractures, lateral epicondyle

Please select a treatment option:
Treatment Indication summary Skill Equipment
Sling with or without splinting Minimally displaced or patient not fit for surgery Basic surgical experience, no specialized skills Basic equipment only
Open reduction; screw fixation Any significant displacement. Incarceration in joint. Varus instability of elbow Some specialized surgical experience Simple surgical and imaging resources
A1.2

Extraarticular apophyseal avulsion fractures, medial epicondyle

Please select a treatment option:
Treatment Indication summary Skill Equipment
Sling with or without splinting Minimally displaced or patient not fit for surgery Basic surgical experience, no specialized skills Basic equipment only
Open reduction; screw fixation Any significant displacement. Valgus instability of elbow. Ulnar nerve compromise Some specialized surgical experience Simple surgical and imaging resources
A1.3

Extraarticular apophyseal avulsion fractures, medial epicondyle, incarcerated

Please select a treatment option:
Treatment Indication summary Skill Equipment
Open reduction; screw fixation Surgery always indicated Highly experienced and skilled surgeon Simple surgical and imaging resources
A2.1/2

Extraarticular fractures, metaphyseal simple, oblique downwards

Please select a treatment option:
Treatment Indication summary Skill Equipment
Sling with or without splinting 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
Open reduction; plate fixation Majority of displaced fractures. Nerve or vessel injury Highly experienced and skilled surgeon Simple surgical and imaging resources
A2.3

Extraarticular fractures, metaphyseal simple, transverse

Please select a treatment option:
Treatment Indication summary Skill Equipment
Sling with or without splinting 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
Open reduction; plate fixation Majority of displaced fractures. Nerve or vessel injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
A3.1/2

Extraarticular fractures, metaphyseal wedge, multifragmentary

Please select a treatment option:
Treatment Indication summary Skill Equipment
Sling with or without splinting 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
Open reduction; plate fixation Majority of displaced fractures. Nerve or vessel injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
A3.3

Extraarticular fractures, metaphyseal multifragmentary, complex

Please select a treatment option:
Treatment Indication summary Skill Equipment
Sling with or without splinting 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
Open reduction; plate and screw fixation Treatment of choice for displaced fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources
B1

Partial articular fractures, lateral sagittal

Please select a treatment option:
Treatment Indication summary Skill Equipment
Open reduction; screw fixation Single fragment, low demand patient, good bone quality Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; lag screw and protection plate Large fragment, high demand patient Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction; plate fixation Large single fragment, high demand patient Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction; plate and screw fixation (+/- headless screws) Multifragmentary fragment +/- associated osteochondral fragment(s) Highly experienced and skilled surgeon Full specialized surgical and imaging resources
B2.1

Partial articular fractures, medial sagittal, medial transtrochlear simple

Please select a treatment option:
Treatment Indication summary Skill Equipment
Open reduction; screw fixation Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
B2.2

Partial articular fractures, medial sagittal, transtrochlear simple, through the groove

Please select a treatment option:
Treatment Indication summary Skill Equipment
Open reduction; plate and screw fixation Most 13-B2.2 fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources
B2.3

Partial articular fractures, medial sagittal, transtrochlear multifragmentary

Please select a treatment option:
Treatment Indication summary Skill Equipment
Open reduction; plate and screw fixation All 13-B2.3 fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources
B3.1

Partial articular fractures, frontal, capitellum

Please select a treatment option:
Treatment Indication summary Skill Equipment
Open reduction; headless screw fixation Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
B3.2

Partial articular fractures, frontal, trochlea

Please select a treatment option:
Treatment Indication summary Skill Equipment
Open reduction; headless screw fixation All 13-B3.2 fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources
B3.3

Partial articular fractures, frontal, capitellum and trochlea

Please select a treatment option:
Treatment Indication summary Skill Equipment
Open reduction; screw fixation +/- protection plate All 13-B3.3 fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources
C1

Complete articular fractures, articular simple, metaphyseal simple

Please select a treatment option:
Treatment Indication summary Skill Equipment
Open reduction; perpendicular (biplanar) plating Surgeon's preference - biomechanically more stable Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction; parallel (uniplanar) plating Surgeon's preference Highly experienced and skilled surgeon Simple surgical and imaging resources
C2

Complete articular fractures, articular simple, metaphyseal multifragmentary

Please select a treatment option:
Treatment Indication summary Skill Equipment
Open reduction; perpendicular (biplanar) plating Surgeon's preference - biomechanically more stable Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; parallel (uniplanar) plating Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
C3

Complete articular fractures, multifragmentary

Please select a treatment option:
Treatment Indication summary Skill Equipment
Open reduction; perpendicular (biplanar) plating Surgeon's preference. Choice determined by fracture anatomy Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; parallel (uniplanar) 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
Complications
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