Crisscross-type screw fixation for transcondylar fractures of distal humerus in elderly patients

This study presents the outcomes of low transcondylar fractures of the distal humerus treated by closed reduction and internal fixation with two screws in a crisscross orientation.

Between 2003 and 2009, ten consecutive elderly patients (1 man and 9 women) with transcondylar fractures of distal humerus (AO 13A2.3) were included in this study. The average age at the time of injury was 72 years (range 63-82). All were closed injuries without nerve injury. The mechanism of the injuries was low-energy fall or slip. Six patients had medical or other systemic diseases.

After a closed reduction of the fracture fragments, two guide wires were inserted in a crisscross orientation; one from the lower lateral edge of the capitellum to the medial cortex of the distal humerus, and the other from the lower medial edge of the trochlea to the lateral cortex of the distal humerus. After drilling, fully threaded cannulated screws (4.5 mm in diameter) were inserted along the each guide wire. Functional outcome was assessed with Mayo Elbow Performance scores.

The mean operation time was 55 min (range 40-100 min). The average follow-up duration was 26.8 months (range 24-35 months). The mean Mayo Elbow Performance scores were 93.8 (range 90-99). The elbow extension-flexion arc was 12(o)-125(o). The mean pronation-supination angle was 74(o)-72(o).

In geriatric patients with transcondylar fractures of the distal humerus, a crisscross fixation with two cannulated screws provides satisfactory results that allow a nearly full range of elbow motion with minimal surgical morbidity.