Distal intraarticular humerus fracturesCimerman MatejDpt. for Traumatology Univ. Clinical Centre Ljubljana, Slovenia

factsdistal 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...every senior trauma and orthopedic surgeon should know to treat basics of these fracturesand should know and respect his limitsevery big trauma center needs some monomaniacs

dr.Koroec Branko

treatment of articular fractures (we know everything)...anatomical reduction and stable fixationmetaphyseal defects should be grafted to prevent articular displacementmetaphyseal and diaphyseal displacement should be reduced to prevent joint overloadingimmediate motion (AO, Shatzker 1987)

easy to say, difficult to realizesmall bone fragmentsa lot of elderly people with osteopenic bonedifficult approachelbow joint hates even short immobilizationlong lever arms

classification: AO MuellerB1B2B3B: partial articular (like partial pregnant)

classification: AO MuellerC1C2C3C: complete articular

imagingAP standard viewsCT and 3D

imaging

surgical anatomy15PA A PML

positioninglateral decubitusprone

approachposterior with olecranon osteotomy(with identification or transposition of ulnar nerve) posterior triceps splittingV triceps aponeurosis flapparatricipital posterior approachanconaeus flap extensile approachlateral approachmedial approach

olecranon osteotomyChevron osteotomy, Koroec chissel, oscilating saw and chissel

triceps splitting

reduction and fixation strategyreducing and fixation of joint componentscoupling to methaphisys

implantsDCP 3,5mm plates are golden standard1/3 small tubular plates for radial columnLC DCP 3,5mm platesprecontoured platesboth plates posteriorright angle config

do not be afraid of ulnar nerve

ulnar nerveidentification is necessarycomplete visualization and transposition only if necessary

postopactive exercise under the control a soon as possible

complicationsstiffness: arthrolysis, salvage proceduresnon union: refixation, TEPinfectionulnar nerve paresis: revisions

conclusionsrespect the fracture and your limitsolecranon osteotomy for C type fractures3.5 mm reco plates golden standardLC 3.5mm reco plates, 1/3 tubular plates and precontoured platesidentify ulnar nervestable fixation mandatoryendoprosthesis as an option