Minor comminution is common. Significant comminution is rare, particularly in younger children.
Closed reduction and percutaneous K-wiring therefore, usually result in accurate reduction and stability. The technique described for single fractures (13-M/3.1 III and 13-M/3.1 IV) is used.
If there is medial impaction, particular attention should be paid to restoring Baumann's angle and thereby avoiding varus malposition.
In unusual fractures that are axially unstable, alternative techniques, such as external fixation or overhead olecranon traction, can be applied.
Skeletally immature adolescents
Younger adolescents, with multifragmentary fractures can be managed using approaches described for adults, ie, prone, or lateral, positioning with two column exposure and fixation.
After provisional fixation of both columns with K-wires, the relative stability of the construct can be assessed and decisions about definitive fixation made.
Plate fixation is usually appropriate for the more comminuted column but it is not always necessary to plate both columns.
The noncomminuted column may be treated with K-wires or cannulated screws. This limits dissection and reduces the bulk of implants.
A plate may be used on the noncomminuted column if additional stability is necessary.
Skeletally mature adolescents
High-energy, multifragmentary fractures may occur in skeletally mature adolescents.
These fractures cannot be adequately stabilized with K-wires alone.
The recommended treatment for a completely unstable, adult pattern fracture, involves two plates at right angles, to provide anatomical reduction and allow early motion.
This treatment is appropriate for the older adolescent and the more unstable comminuted fracture pattern.
Please refer to 13-A3.2 fractures in adult AO Surgery Reference.