Complex coronal shear fractures of the distal humerus

This is a retrospective review of nine coronal shear fractures of the distal humerus. Two were isolated fractures and seven were associated with other peri-articular elbow injuries, termed "complex" coronal shear fractures. All cases underwent immediate open reduction and internal fixation (ORIF) and were then followed for an average of 14 months (range: 6.5 to 23 months) with outcomes evaluated using the Mayo Elbow Performance Scoring system. There was a significant difference found between injuries limited to the radiocapitellar (RC) joint (isolated coronal shear fractures, or those associated only with radial head fractures) and the complex injuries extending beyond the RC joint. Scores for the RC injuries were 100 and other complex injuries had an average score of 69 (range: 35 to 95; p = .025). All complications were limited to the group with the complex injuries, including stiffness, nonunion, pain, and gross instability. Much of the current thinking in treatment of this fracture was upheld in this study; computed tomography aids in diagnosis, ORIF is a necessity, and there is a need for anatomic reduction. When a coronal shear fracture is complicated by a concomitant injury outside the RC joint, both the surgeon's and patient's expectation need to be adjusted accordingly.