Intra-Articular Osteotomy for Distal Humerus Malunion

René K Marti,Job Doornberg

doi:10.1155/2009/631306

Abstract

Intra-articular osteotomy is considered in the rare case of malunion after a fracture of the distal humerus to restore humeral alignment and gain a functional arc of elbow motion. Traumatic and iatrogenic disruption of the limited blood flow to the distal end of the humerus resulting in avascular necrosis of capitellum or trochlea is a major pitfall of the this technically challenging procedure. Two cases are presented which illustrate the potential problems of intra-articular osteotomy for malunion of the distal humerus.

Highlights

Distal humerus fractures are uncommon, accounting for only 2 percent of all fractures [1]
In the case of an extra-articular osteotomy to correct flexion or extension alignment, treatment can be indicated despite the presence of posttraumatic arthrosis of an incongruent elbow joint
McKee and Jupiter reported on two malunited fractures of the distal humerus that underwent intra-articular osteotomy in a series of distal humerus malunion and nonunion with good results [6]

Summary

Introduction

Distal humerus fractures are uncommon, accounting for only 2 percent of all fractures [1]. In the rare case of malunion, intra-articular or supracondylar osteotomy to restore humeral alignment and provide a more useful arc of motion is legitimate. In the case of an extra-articular osteotomy to correct flexion or extension alignment, treatment can be indicated despite the presence of posttraumatic arthrosis of an incongruent elbow joint.

Results

Conclusion