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Distal Humeral Fracture Fixation with an Extensor Mechanism-on Approach.

Jason M Erpelding1, Matthew A Mormino2, Edward V Fehringer2

  • 1Medical College of Wisconsin, 8700 Watertown Plank Road, Milwaukee, WI 53226.

JBJS Essential Surgical Techniques
|July 20, 2019
PubMed
Summary
This summary is machine-generated.

Open treatment of distal humeral fractures using an extensor mechanism-on approach is effective. This surgical technique facilitates fracture healing and allows for significant elbow range of motion post-operatively.

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Area of Science:

  • Orthopedic Surgery
  • Traumatology
  • Skeletal Repair

Background:

  • Distal humeral fractures, both extra-articular and intra-articular, present complex challenges in orthopedic treatment.
  • The extensor mechanism-on approach offers a viable surgical strategy for managing these fractures.

Purpose of the Study:

  • To detail the surgical technique for open reduction and internal fixation of distal humeral fractures using an extensor mechanism-on approach.
  • To report the outcomes, including fracture healing and functional recovery, in patients treated with this method.

Main Methods:

  • Preoperative assessment involves multiplane imaging to identify fracture lines involving the capitellum or trochlea.
  • The surgical approach includes medial and lateral arthrotomies, fat pad excision, and anatomical reduction of fragments.
  • Definitive fixation is achieved with plates and screws, ensuring maximal length and engagement of opposite columns.

Main Results:

  • In a series of 37 patients, all fractures achieved primary healing.
  • The median elbow range of motion was 126° (range, 60°–141°).
  • Median triceps strength loss was 10% (range, 0%–49%).

Conclusions:

  • The extensor mechanism-on approach is an effective method for open treatment of distal humeral fractures.
  • This technique leads to successful fracture healing and restoration of elbow function, with manageable strength deficits.