Abstract
Fractures of the distal humerus present a challenge. The fractures are often intra-articular and the bone osteoporotic. The elbow tolerates surgery and immobilisation poorly, and it is difficult to secure rigid fixation. Union must be achieved and elbow motion preserved. The results of fixation of fractures of the distal humerus are unpredictable. Fixation with two plates at 90° angles to one another has become the standard against which all other treatment is measured. Following up patients for a mean of 24 months, the author conducted a prospective study evaluating posterior plating of the two columns of the distal humerus with reconstruction plates and intercondylar fixation.
Between 1996 and 2000, 18 women and seven men with unilateral intra-articular fractures of the distal humerus were treated. Their mean age was 46 years (35 to 71). The fractures were classified according to the AO classification: there were 22 type-CII and three type-CIII. Four fractures were compound.
One of two posterior approaches was used, either through the triceps aponeurosis or using an olecranon osteotomy. Postoperative management included prophylactic intravenous antibiotics for 48 hours and a posterior splint for 7 to 10 days. Active movement commenced once sutures were removed, but patients avoided active or resisted extension for six weeks. The mean time to union was 16 weeks. Patients attained a mean range of elbow movement of 105° (35° to 135°). One patient developed superficial sepsis but recovered after treatment with antibiotics. One patient with a compound injury developed a deep infection, which required multiple debridements, gentamycin beads and bone grafting to achieve union. There were no implant failures or cases of nerve paralysis.
This study demonstrated no differences in functional outcome between triceps aponeurosis or olecranon osteotomy approach. Union and satisfactory functional results were achieved with posterior plating of the columns and intercondylar fixation.
The abstracts were prepared by Professor M. B. E. Sweet. Correspondence should be addressed to him at The Department of Orthopaedic Surgery, Medical School, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
