Distal intraarticular humerus fractures

$Page 1: Distal intraarticular humerus fractures$
Dpt. Of TraumatologyDpt. Of Traumatology

KC LJUBLJANAKC LJUBLJANA

Distal intraarticular Distal intraarticular humerus fractureshumerus fractures

Cimerman MatejDpt. for Traumatology

Univ. Clinical Centre Ljubljana, Slovenia



factsfacts

• distal humerus fractures remain one of the most demanding challenges in orthopedic and trauma surgery (Korner, J Orthop Trauma 2004, Soon, Injury 2004)

• distal humerus fractures in adults are rare (2-6% of all fractures)

• unsatisfactory results in 20% (Jupiter and Morrey, 1993)



solution...solution...

• every senior trauma and orthopedic surgeon should know to treat basics of these fractures

• and should know and respect his limits

• every big trauma center needs some monomaniacs



• † dr.Korošec Branko



treatment of articular treatment of articular fractures (we know fractures (we know

everything)everything)• ...anatomical reduction and stable

fixation• metaphyseal defects should be

grafted to prevent articular displacement

• metaphyseal and diaphyseal displacement should be reduced to prevent joint overloading

• immediate motion (AO, Shatzker 1987)



easy to say, difficult to easy to say, difficult to realizerealize

• small bone fragments• a lot of elderly people with

osteopenic bone• difficult approach• elbow joint hates even short

immobilization• long lever arms



classification: AO Muellerclassification: AO Mueller

B1B1 B2B2

B3B3

B: “partial articular” (like partial pregnant)B: “partial articular” (like partial pregnant)



classification: AO Muellerclassification: AO Mueller

C1C1 C2C2 C3C3

C: complete articular



imagingimaging

• AP standard views• CT and 3D



imagingimaging



surgical anatomysurgical anatomy

1515°°

PP

AA

AA

PP

MMLL



positioningpositioning

lateral decubituslateral decubitus proneprone





approachapproach

• posterior with olecranon osteotomy(with identification or transposition of ulnar

nerve) • posterior triceps splitting• “V” triceps aponeurosis flap• paratricipital posterior approach• anconaeus flap extensile approach• lateral approach• medial approach



olecranon osteotomyolecranon osteotomy

Chevron osteotomy, Korošec chissel, oscilating saw and chissel







triceps splittingtriceps splitting







reduction and fixation reduction and fixation strategystrategy

• reducing and fixation of joint components

• coupling to methaphisys



implantsimplants

• DCP 3,5mm plates are golden standard

• 1/3 small tubular plates for radial column

• LC DCP 3,5mm plates• precontoured plates• both plates posterior• right angle config















do not be afraid of ulnar do not be afraid of ulnar nervenerve



ulnar nerveulnar nerve

• identification is necessary• complete visualization and

transposition only if necessary



postoppostop

• active exercise under the control a soon as possible



complicationscomplications

• stiffness: arthrolysis, salvage procedures

• non union: refixation, TEP• infection• ulnar nerve paresis: revisions



conclusionsconclusions

• respect the fracture and your limits• olecranon osteotomy for C type

fractures• 3.5 mm reco plates golden standard• LC 3.5mm reco plates, 1/3 tubular

plates and precontoured plates• identify ulnar nerve• stable fixation mandatory• endoprosthesis as an option

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Distal intraarticular humerus fractures