Current Trends in Management of Distal Humeral Fracture In Adult

Abstract

The treatment of distal humeral fractures presents a challenge to the orthopaedic surgeon. Flattening of the humerus distally, the presence of the olecranon and coronoid fossae, the neurovascular structures in close proximity to the elbow and some physiological angulations that must be preserved make the surgical procedure difficult. Osteoporosis and severe comminution are also not uncommon in these injuries. Unfortunately, despite anatomic reduction and stable fixation, the functional outcome can also be affected by heterotopic ossification, joint stiffness or ulnar neuropathy. Although the transolecranon approach requires the creation of an additional intra-articular fracture, the incidence of complications in this approach is reported to be very low. The V-shaped osteotomy and cracking the articular surface provides easily repositioned, irregular and interdigitating fracture ends. This approach provides excellent exposure of the articular surface and distal humerus; it also permits ulnar nerve transposition. In addition to these, no deleterious effects are noted, such as the soft-tissue fibrosis experienced with triceps splitting approach. Ulnar nerve transposition routinely done. The best accepted management in these fractures is a meticulous open reduction with stable internal fixation using parallel plates to each other for two-plate fixation and early active physical therapy.