Supracondylar fractures of the elbow: open reduction, internal fixation

This principle-based approach for fixing distal humerus fractures has many advantages. Complex fractures are able to be fixed with sufficient stability to permit immediate intensive rehabilitation. Some fractures believed to be unfixable have been fixed satisfactorily by applying the principles outlined in this article. More straightforward fractures are fixed easily using the same techniques. In the author's experience, the stability achieved with this approach is so much greater than that with traditional methods of fixing distal humerus fractures that bone graft has been required only rarely, despite the severity of injuries so typical of the tertiary referral nature of the author's practice. The key points are that the plates should be placed in parallel configuration medially and laterally and that the screws passing through these plates in the distal fragments should interdigitate and lock together.