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Management of intra-articular fractures of distal humerus with two column fixation with orthogonal plate construct

Authors: Manjit S. Daroch, Sanjeev Sreen, Deepak Vashisht and Parveen Puri

Int J Med Res Health Sci.159-165 | pdf PDF Full Text

Accurate reconstruction of articular surface of distal humerus by closed manipulation is not possible. The recent
trend for displaced intra-articular fractures of the distal humerus is open reduction and stable osteosynthesis with
early rehabilitation. We hypothesized that the best exposure of both columns and articular surface of the distal
humerus is achieved through trans-olecranon approach and fixation of two columns of intra-articular fracture of
distal humeruswith orthogonal plate construct would allow excellent stability and good healing to restore early
elbow joint function. 40 cases of intra-articular fractures of distal humerus were treated by open reduction and
internal fixation (ORIF) with orthogonal plate construct via transolecranon approach. Chevron type olecranon
osteotomy was performed and fixed with tension band wiring in all cases. Periodical radiological evaluationand
regular clinical examination were done as per Mayo elbow Performance score. All fractures united within average
duration of 3 months. More than 100
0 of range of motion is attained in 70% of cases with mean motion of arc of
115
0. The mean Mayo Elbow Performance Score was 90.25 indicating excellent results with mild impairment. The
critical factors for a successful outcome of intra-articular fractures of the distal humerus depends upon meticulous
surgical technique, stable internal fixation, surgical experimentation and early controlled postoperative
mobilization. ORIF with orthogonal plate construct securing both humeral columns via transolecranon approach
results in excellent healing by maintaining functional arc of motion.

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