[The treatment of distal upper arm fractures]

The treatment of fractures of the distal humerus is very well standardized. The classification according to Müller allows for easy differentiation between the many types of fractures, helps in the determination of therapeutic guidelines and contributes to an objective comparison of results of treatment. Fractures in group A/B are treated either conservatively or with comparatively simple instrumentation using K-wires, screws, and plates. Injuries falling in group C demand a high standard of operative skill. The underlying principle of internal fixation aims primarily at reconstruction of the articular surface. The next operative step consists in the realignment of the reconstructed articular block with the proximal humeral fragment by osteosynthesis. Autologous cancellous bone is used to give a solid counterbalance for screw fixation and to re-establish osseous continuity. Sound assessment of concomitant injury to the soft tissue demands wide clinical experience. This is necessary for essential decision as to whether primary osteosynthesis, delayed, secondary reconstruction of the joint following recovery of the soft tissue or conservative treatment is indicated.