Coronal Plane Articular Shear Fractures of the Distal Humerus

Area of Science:

• Orthopedic Surgery
• Traumatology
• Radiology

Background:

• Coronal plane articular shear fractures of the distal humerus are uncommon, representing 6% of distal humerus injuries.
• These fractures are frequently underestimated on initial radiographs, often showing greater posterior comminution and trochlear involvement than apparent.
• Associated bony and ligamentous injuries are common, complicating management.

Purpose of the Study:

• To review the diagnostic challenges and treatment strategies for coronal plane articular shear fractures of the distal humerus.
• To highlight the importance of a high index of suspicion for accurate diagnosis.
• To discuss surgical approaches and fixation methods based on fracture patterns.

Main Methods:

• Review of literature on distal humerus shear fractures.
• Analysis of radiographic and intraoperative findings.
• Discussion of surgical techniques including lateral and anterolateral approaches.
• Evaluation of fixation methods such as headless compression screws and locking plates.

Main Results:

• Plain radiographs often underestimate fracture complexity, particularly posterior comminution and trochlear involvement.
• Anatomic reduction and internal fixation are the standard of care, with non-surgical treatment yielding poor results.
• The lateral approach is suitable for simpler patterns, while the anterolateral approach may improve trochlear exposure.
• Posterior comminution often necessitates locking plate fixation.
• Lower complication rates are associated with less fragmented articular surfaces and absence of posterior comminution.

Conclusions:

• Coronal shear fractures of the distal humerus require a high index of suspicion for diagnosis.
• Surgical management is preferred, with technique selection dependent on fracture characteristics.
• Outcomes are better in less complex fractures, emphasizing the need for precise surgical reduction and fixation.
• Common reasons for revision surgery include contracture and symptomatic implants.