Management of type C distal humeral fracture using Von Gorder approach

Abstract

Introduction: Exposure of articular fragments is a key factor to achieve accurate anatomical reduction in distal humeral fractures. Olecranon osteotomy is considered as gold standard for these fractures. Von Gorder's approach allows exposure of articular surface by forming an inverted V-shaped flap of distal tricep in the distal humeral fracture. We evaluated the functional outcome in the management of distal humeral fractures treated by open reduction and internal fixation by Von Gorder's approach. Method and Material: Total 22 patients with AO Type C distal humeral fracture were taken, C1 include 11, C2 includes 5 and rest 6 were C3 type. All patients were managed by open reduction and internal fixation through Von Gorder approach. Out of 22 bicolumnar fracture,19 were by recon plate and dynamic compression plate while 3 fractures were fixed by pre-contoured locking plates. Cases were followed up clinically as well as radiologically. Functional outcomes of patient were accessed in terms of Mayo Elbow Performance score (MEPS). Results: All patients had shown radiological union at an average 12.4 weeks, 17 (77%) patients had shown good to excellent score, 4 patients (18%) had fair outcome while 1 (4%) had poor outcome Mean MEPS score at final recent follow-up was 87. No patient had loss of rotatory motion although 86% patients had loss of terminal range of flexion/extension as compared to the normal side but their functional range of movement was good. The range of flexion was 123.0° (range 90°-135°), range of extension was 7° (range 0°-13°). Conclusion: Tricep Reflecting approach can be used in management of most of the distal humeral fractures as it provides adequate visualization and reduction however fractures having communition of trochlea and fractures involving anterior capitellum should not be attempt with this approach.