Distal humeral fracture 2 Case for small group

Distal humeral fracture (2) Case for small group discussion: Upper extremity fractures—decision making and methods of stabilization AO Trauma Advanced Principles Course

Case history • • • 26 -year-old man High-velocitiy ski accident (fall onto the right elbow) 1 st degree open distal humeral fracture Neurovascular intact Monotrauma Initial treatment?

Transferred from another hospital Additional images required? Day 3

CT

• Fixation? • Positioning? • Osteotomy type? Surgical tactic of reconstruction - Joint block first, then reduction of joint block to the shaft - Ulnar column first ? - Radial column first ?

Positioning

1. Reconstruction ulnar trochlea with articular compression screw 2. Reduction ulnar joint block to shaft 3. Reduction radial column to shaft

1. Radial column plate 2. Filling defect with cancellous bone graft 3. Reduction and fixation Chevron osteotomy

Intraoperative images

Postoperative day 1 Follow-up at 6 weeks

Follow-up at 12 weeks Follow-up at 6 months

1 year postop

Function: ROM F/E 120/30/0

Summary and take home message • Imaging: CT or traction view • After local debridement, temporary fixation • Operative tactics - AO 13 -C 3 fractures need Chevron osteotomy - Joint reconstruction with miniscrews • Reduction and fixation: - «Easier» column first - Reduction of the other column against the reconstructed column - Bone graft in defective situations