Best care paradigm to optimize functionality after extra-articular distal humeral fractures in the young patient

Abstract

For younger patients with extra-articular distal humerus fractures closed management is plagued with high rates of malunion, suboptimal functional outcomes, extended immobilization with loss of early motion, a delay in return to work, and a general period of lost productivity. Surgical management offers an appealing alternative. Maintaining respect for the triceps musculature and minimizing iatrogenic injury to the radial nerve are primary concerns with operative treatment. Accordingly, use of a triceps-sparing approach and single column plating may be the optimal treatment paradigm in the young patient presenting with an extra-articular distal humerus fracture.

Keywords: Dual column plating; Extra-articular distal humerus fracture; Sarmiento bracing; Single column plating.

Fig. 1

Malunion of open distal humerus fracture managed in Sarmiento brace initially. Anteroposterior (a) and lateral (b) radiographs with 13 ° varus and 27 ° procurvatum deformity. Patient desired correction of deformity and elbow contracture release secondary to pain, limited motion and cosmetic appearance. (c) Operative correction of malunion with opening wedge osteotomy, tricortical autograft, and dual column plating.

Fig. 2

Lateral paratricipital exposure for distal humeral fracture reconstruction heralded for optimal fracture exposure for reduction and instrumentation. Limited iatrogenic muscle damage to triceps compared to splitting method. Radial nerve palsy avoided as release of the lateral intermuscular septum takes tension off of the nerve during fracture care.

Fig. 3

Clinical case of distal humerus fracture managed with direct reduction through lateral paratricipital exposure. Single column plating employed with a locked periarticular plate resulting in uneventful union without deformity.

Fig. 4

For unstable distal humerus fractures, such as this open variant with metaphyseal bone loss (a), dual column lateral plating is an alternative to exposure and instrumentation of the medial column (b).