Transolecranon Approach Research Articles

Treatment of complex intercondylar humeral fractures in adolescents by open reduction and internal fixation through the transolecranon approach

This is a review of six cases of complex intercondylar fractures of the humerus in adolescents, treated operatively through a transolecranon approach. Outcome was assessed by means of the Mayo Elbow score, the Disability of the Arm, Shoulder and Hand score, and the Oxford Elbow score. All patients reported 'good' to 'excellent' results. One patient required revision surgery because of fracture nonunion, and all patients underwent removal of hardware from the olecranon after osteotomy union. The transolecranon approach is effective in visualization of complex intercondylar fractures, and good outcomes are expected following stable surgical fixation in adolescents.

Treatment of distal humerus fractures with LCP DHP™ locking plates in patients older than 65 years

Fractures of the distal humerus are often complex and therefore challenging to treat. In elderly patients with decreased bone strength due to osteoporosis, strong fixation is crucial to allow resuming early motion that guarantees a good functional outcome as well as minimising mechanical complications. Locked implants meet these requirements. Here, we report outcomes in a uniform series of patients older than 65 years with distal humerus fractures managed with LCP DHP(®) (Synthès) fixation. Our objective was to evaluate the efficacy and limitations of this technique. LCP DHP provides strong fixation of osteoporotic bone and leads to good clinical and radiological outcomes. We retrospectively studied 46 consecutive patients (2004-2010) with a mean age of 80 years including 15 with extra-articular and 31 with articular distal humerus fractures. At presentation, 11 complications were noted in nine patients (compound fractures and trauma-related nerve injuries). The transolecranon approach was used in 31 patients. Mean duration of immobilisation was 2.7 weeks in 33 patients. Forty-three patients were re-evaluated after a mean follow-up of 25 months (range, 10-64 months); two patients died and one was lost to follow-up. Flexion was 127° and loss of extension was 23°, producing an average range of motion of 104°. Functional recovery was highly satisfactory with a Mayo Clinic Performance Score of 87 (70-100) and 95% of good and very good results. Postoperative complications consisted of infection (n=3), metaphyseal non-union (n=2), ulnar nerve injury (n=6), transient radial nerve palsy (n=1), and peri-articular ossification (n=4). Compound fracture and worse AO fracture type were associated with worse functional outcomes. Despite the high complication rate, functional recovery was similar to that reported in previous case series, including after arthroplasty. Furthermore, the rate of mechanical complications was lower. Thus, our working hypothesis was confirmed. Level IV retrospective non-comparative study.

Complex fractures of the distal humerus in the elderly: Is primary total elbow arthroplasty a valid treatment alternative? A series of 20 cases

Distal humerus fractures are fairly rare. But as our population ages, these fractures become more complex and the choice of treatment more delicate. Poor bone quality results in many technical problems and the fixation hardware stability remains at risk. The goal of this study was to evaluate the functional recovery and morbidity of complex distal humerus fractures in elderly patients when treated with elbow prosthesis. Good functional recovery can be achieved with a total joint replacement. This series consisted of 20patients (18 women and two men) having an average age of 80years (range 65-93, median 80). Based on the AO classification, there were two TypeA2 fractures, two TypeB fractures, 15 TypeC fractures and one fracture that could not be classified because of previous rheumatoid disease history at this elbow. Two fractures were open. In two cases, the olecranon was also fractured. Treatment consisted of the implantation of a Coonrad-Morrey, hinge-type total elbow prosthesis (Zimmer(®), Warsaw, IN, USA). The Mayo Clinic surgical approach was used 17 times and the transolecranon approach was used three times. Primary arthroplasty was performed in 19 cases and the surgery was performed after six weeks of conservative treatment (diagnostic delay) in one case. Unrestricted motion was allowed after surgery, but a maximum of 0.5kg could be carried during the first 3months; this was subsequently increased to 2.5kg. Fifteen of the 20patients were available for reevaluation with an average follow-up of 3.6years (range 1.7-5.5, median 3.4). Four patients had died and one was lost to follow-up. The average range of motion was 97° (range 60-130°), comprising an average flexion of 130° (range 110-140°) and average loss of extension of 33° (range 0-80°). Pronation and supination were normal. The average Mayo Elbow Performance Score (MEPS) was 83 (range 60-100, median 80). X-rays revealed seven cases of radiolucent lines, with two being progressive. There was no visible wear of the polyethylene bushings at the hinge. Six patients had moderate periarticular heterotopic ossification. The two cases of olecranon osteotomy and one case of olecranon fracture had healed. There were no surgical site infections but two cases of ulnar compression, one of which required neurolysis. There was one case of humeral component loosening after 6years, but the implant was not changed. The clinical range of motion results were comparable to published data. The functional scores were slightly lower, mainly because of the pain factor. The initial results were encouraging and consistent with published data as long as the indications were well-chosen. Based on this retrospective study, total elbow arthroplasty can be a valid alternative in the surgeon's treatment armamentarium for complex distal humerus fractures in elderly patients who have moderate functional demands. Our results support our hypothesis, since we found good functional recovery without associated morbidity. Level IV retrospective study without comparator.

Surgical Treatment Using a Transolecranon Approach with a Dual Locking Plate for Unstable Intercondylar Fractures of the Humerus

129 통신저자:조 병 기 청주시 흥덕구 성봉로 410 충북대학교병원 정형외과 Tel:043-269-6077ᆞFax:043-274-8719 E-mail:titanick25@yahoo.co.kr 접수: 2011. 8. 15 심사 (수정): 2011. 9. 25 게재확정: 2011. 12. 16 Address reprint requests to:Byung-Ki Cho, M.D. Department of Orthopedic Surgery, Chungbuk National University Hospital, 410, Seongbong-ro, Heungdeok-gu, Cheongju 361-711, Korea Tel:82-43-269-6077ᆞFax:82-43-274-8719 E-mail:titanick25@yahoo.co.kr 경주두 도달법과 이중 잠김 금속판을 이용한 상완골 과간 골절의 치료

Paratricipital-Triceps Splitting “Two-Window” Approach for Distal Humerus Fractures

Commonly, distal transcondylar and intra-articular distal humerus fractures are treated through a transolecranon approach. Other options for exposure, open reduction, and internal fixation exist to prevent the reported complications of olecranon osteotomy. The technique of triceps sparing access, as it has been reported before by others, allow adequate exposure in most of distal humerus fractures except for multifragmentary, mainly intra-articular types. We demonstrate the technique of the "two-window" approach, which combines a paratricipital posteromedial access with splitting the triceps lateral to the triceps tendon. Through a posteromedial incision, all surfaces of the distal humerus were accessed without muscle detachment from the olecranon. This approach does not compromise the ligamentous joint stability. In addition, the stabilizing effect of the anconeus muscle is not impaired because continuity with the lateral portion of the triceps is preserved, and denervation is avoided. It is extensile and provides adequate exposure of articular fracture comminution with the added advantage of the intact olecranon as a template for reduction. However, because the triceps is still in continuity it permits conversion to a transolecranon approach as necessary. The two-window approach is our preferred approach for all distal humerus fractures inclusively C3 fractures according to the ASIF/AO classification, except for complex volar shear fractures.

One-third tubular-hook-plate osteosynthesis for olecranon osteotomies in distal humerus type-C fractures: A preliminary report of results and complications

IntroductionDistal humerus fractures are rare and challenging to treat. Anatomic reduction of the articular surface and stable osteosynthesis are mandatory for satisfactory results. The transolecranon approach allows superior visualisation of the joint. However, controversy exists regarding how best to fix the osteotomy. The purpose of the present study was to investigate the eligibility of a one-third tubular hook plate for osteosynthesis of olecranon osteotomies in distal humerus type-C fractures. Patients and methodsA consecutive series of 34 patients who were treated through an olecranon osteotomy and underwent fixation using a one-third tubular hook plate were identified. Thirty-one patients (17 females, 14 males) with a median age of 50 years (14–87, standard deviation (SD) 18.3) were available for a comprehensive assessment after a mean of 12.3 months (6–20, SD 3.7). Using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, six (19.4%) fractures were categorised as type C2 and 25 (80.6%) were categorised as C3. Physical and radiological examinations were performed. The Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder and Hand score (DASH) were evaluated. ResultsMean extension–flexion ROM was found to be 102° (50–145°, SD 25). Pronation and supination were only slightly compromised. The mean MEPS was 87.2 points (50–100, SD 12.4). Fourteen patients (45.2%) were rated as excellent, and 15 (48.4%) were rated as good. One patient was rated fair, and one patient was rated as poor, respectively. Mean DASH score was 24.4 points (0–65, SD 20.3). Complications regarding the osteotomy occurred in seven patients (22.5%). Revision surgery was necessary in five cases (16%). At follow-up, all osteotomies went on to union. Mild joint degeneration (Broberg I) was found in 10 patients (32.2%). Implant removal was carried out in 15 patients (48.4%). ConclusionBased on this study, the osteosynthesis of olecranon osteotomies using a one-third tubular hook plate can be regarded as a safe procedure with a low complication rate. The implant needed is widely available and cost-efficient, in contrast to specially designed plates or nails.

Controversies in the management of intra-articular fractures of distal humerus in adults

Background:The surgical approach, type of olecranon osteotomy, method of stabilization of osteotomy, type of fracture stabilization, orthogonal vs parallel plate fixation, need for transposition of ulnar nerve, place for primary total elbow replacement, and type of rehabilitation schedule after surgical fracture treatment are the controversial issues in the treatment of complex intra-articular distal humerus fractures (C2 and C3) in adults. Severe comminution, bone loss, and osteoporosis at the site of distal articular fractures of humerus often lead to unsatisfactory results due to inadequate fixation. We hereby report the outcome of a series of intracondylar fractures of the humerus treated by open reduction and internal fixation and discuss the controversies in light of published literature.Materials and Methods:One hundred and eighty-four patients of intra-articular fractures of distal humerus (C2 and C3) were operated by posterior transolecranon approach between January 1980 and December 2008. Initially, in the first part Chevron intra-articular osteotomy (n=108) was performed out of which 94 have been published in another publication. In later second part (1993 onward), extra-articular olecranon osteotomy (n=76) was routinely performed. Both columns were stably fixed by orthogonal methods; (n=174) however, during the last 2 years, in 10 patients with severe comminution with bone loss, stabilization was achieved by parallel plating. The osteotomy was routinely stabilized by tension band wiring with two parallel K-wires introduced up to the anterior ulnar cortex. The results were evaluated by the staging system of Caja et al. at a minimum follow-up of 2 years.Results:In the first part of the study (n=94), there was delayed union in 4% (n=4), with the fracture taking more than 20 weeks for union. There was delayed union of ulnar osteotomy (n=3) and failure of one tension band wiring, requiring revision. Some loss of motion was seen in 20% of cases and these patients did not achieve full flexion and extension. However, all these patients had useful range of function, with 20°–110° of flexion and full pronation-supination. As per the staging system of Caja et al., the results were in the range of excellent to good in 72% cases (n=67), fair in 19% (n=18), and poor in 9% patients (n=9). In the second part of study (n=90) dual plate fixation of both columns by orthogonal methods (n=80) and parallel plate fixation in 10 patients was performed. The results were excellent to good in 78 patients (86%).Conclusions:The high rate of union can be achieved in complex intra-articular fractures of distal humerus if the proper principles of stable fracture fixation are followed, i.e., a posterior transolecranon approach and dual fixation of both columns and restoration of the continuity of articular surface. The stability achieved by this technique permits institution of early intensive physiotherapy to restore elbow function.

Outcome of type C (AO) distal humeral fractures: follow-up of 22 patients with bicolumnar plating osteosynthesis

In the last 40 years, 220 patients with type C distal humeral fractures (AO13-C1-3) were treated at our hospital operatively. Aim of this study is to present results of patients treated by dual plating osteosynthesis in the last decade and to compare them with our previous series (A-C). From 1999 to 2008, 48 distal humeral fractures were treated operatively by perpendicular dual plating osteosynthesis. Twenty-two patients (mean age 43.5 years) were available for follow-up. These patients were allocated on the basis of retrospective evaluation, exploration of their medical history, x-rays based on the AO-classification, and functional outcome using CASSEBAUM, JUPITER, and Quick-DASH (Disabilities of the Arm, Shoulder and Hand) scores. The dominant side was affecting in 42.9%. Transolecranon approach was chosen in 86.4%. Good/excellent results were found in 86.4% (CASSEBAUM) and 81.8% (JUPITER). Mean Quick-DASH was 36.1 ± 28.4. Mean range of motion (ROM) was 0/10.9°/128.2°. Mean hospitalization time was 12.9 days, 22.7% were polytrauma patients. Early mobilization was possible in 81.8%. Early mobilization was possible in the majority of cases, which may be a prerequisite for satisfying functional results. Using new locking plates, early mobilization could be maintained even in an aging population.

Bilateral plate fixation for type C distal humerus fractures: experience at a single institution

Type C fractures of the distal humerus are difficult to treat and typically require open anatomical reduction and internal fixation. Here we describe our experience treating patients with type C distal humerus fractures using a trans-olecranon approach with bilateral plate fixation. Fifty-six patients (30 males, 26 females; mean age 49.8 years) were treated over a period of six years. Thirteen fractures were open and 43 closed; all were caused by falls or traffic accidents. All operations were performed successfully with no intraoperative complications. Mean duration of follow-up was 30 months (range 6-70). Mean duration of fracture healing was 2.8 months (range 2-4). Forty-seven out of 56 patients (84%) suffered no postoperative complications. One patient exhibited symptoms of ulnar nerve injury following surgery (nine exhibited symptoms before and after surgery). Two patients had mild cubitus varus deformities, four delayed olecranon osteotomy site healing, and two heterotopic ossifications. In summary, complications were minimal and outcomes satisfactory in patients with type C distal humerus fractures who underwent bilateral plate fixation via a trans-olecranon approach.

Operative Management Of Intercondylar Fractures Of The Distal End Humerus In Adults

This is a prospective study which includes 26 adult patients of intercondylar fracture of distal humerus, both male (20 patients) and female (6 patients) of different age group treated with open reduction and internal fixation with 4.5 mm malleolar screw or 6.5 cancellous screw and reconstructed condyles of the humerus were fixed to the diaphysis with either dual reconstruction plates or one third tubular plates or small fragment DCPs preferably via trans-olecranon approach. Immediate post operative mobilization was started as patient was pain free. Most of the patients (50%) were between age group of 21-40 years. Mode of injury in 18 (70%) cases was road traffic accident and rest cases were due to fall from height. 20 cases (77%) belong to AO/ASIF classification C1 and14 case (54%) belong to Riseborough and Radin’s classification type III. 22 (85%) of 26 cases showed timely union at 18 weeks. Pain and stiffness in 3 (11.5%) patients, implant loosening in 3 (11.5%) patients were the common complications of this study. In our study 13 (50%) patients had range of motion (ROM) between 100 and 120 degrees. Based on Jupitar et al system 20 patients (77%) had ‘Excellent’ to ‘Good’ results and 6 patients (23%) had fair to poor results. INTRODUCTION Intercondylar fractures of the distal humerus are relatively rare and difficult to manage. Since the original description by Desault in 1811, the intercondylar fracture of distal humerus remained one of the most difficult of all the fractures to manage. Although it is a less common fracture, but in the past few years the incidence is increasing due to modernization and increased road traffic accidents. MECHANISM OF INJURY Wilson and Cochrane (1928), described mechanism of injury. They suggested that the separation of condyles in this type of fracture may be created by the splitting effect of humeral shaft as it is forced distally. The injury can occur either in flexion or extension of elbow. The fracture is probably caused by the impact of olecranon in the trochlear groove thereby diverging the condyles of distal humerus apart. MATERIAL AND METHODS This is a prospective study which includes 26 adult patients of intercondylar fracture of distal humerus, both male and female of different age group treated in the Department of Orthopaedics, Government Medical College Jammu. Once the General Condition stabilized, patients were sent for Xrays and fracture was classified according to AO/ASIF as well as Riseborough and Radins’s classifications. However compound fractures were thoroughly irrigated with Normal saline, antiseptic dressing done, limb splinted and then sent for x-rays. OPERATIVE TECHNIQUE ANAESTHESIA AND POSITION General anaesthesia was given and then patient was turned in either lateral or prone position with elbow flexed at 90 and supported on one side of the table. Tourniquet was applied; whole of upper limb was painted with iodine solution and draped with sterile sheets. Tourniquet was inflated and time noted. APPROACH About 20 cm long incision was given extending about 10 cm proximal and 10 cm distal to the elbow joint on the posterior aspect. Subcutaneous tissue and fascia was incised in the line of skin incision. Ulnar nerve is identified first and is retracted medially with a finger of gloves. Fracture site was exposed either through a trans-olecranon approach or campbell’s posterior approach. Assembling of fragments of distal humerus: (1)Reduction and fixation of condyles: Operative Management Of Intercondylar Fractures Of The Distal End Humerus In Adults 2 of 6 Both the condyles were reduced and held together with the help of bone holding clamps. Condyles are temporarily fixed with K-wires and then with 4.5 mm malleolar screw or 6.5 mm cancellous screws of adequate length. K-wire is now removed and stability as well as congruity of joint surface was assessed. ii) Reduction and fixation of condyles to metaphysis After the reduction of condyles to the humerus metaphysis, fixation is done with either single or dual (contoured) reconstruction plates or one third tubular plates or sometimes small fragment DCP and cortical screws. K-wires, malleolar screws or cancellous screws can be used in addition. When transolecranon approach was used, the osteomised olecranon was re-fixed with Tension Band wire.

Les fractures articulaires frontales de l’extrémité distale de l’humérus

The vague term of capitellar fractures is still frequently used to designate articular coronal fractures of the distal humeral epiphysis. The use of eponyms for their descriptions may cause confusion. Recent publications describe a wide variety of fracture types and recommend new classifications based on the operative findings. We report our results of surgical treatment of 12 cases of these fractures in comparison to recent series of the literature. Twelve patients (seven female and five male with a mean age of 31 years and 6 months) have been treated for articular coronal fractures of the distal humeral epiphysis between 1994 and 2004. A retrospective analysis of the radiographs and the operative notes permits their differentiation into 3 types according to the classification of Dubberley et al. (2006): ten fractures of type 1, one fracture of type 2 and one fracture of type 3. All fractures underwent open reduction and internal fixation, except for one case, which was initially missed and operated, therefore, by excision of the articular fragment with a delay of 6 weeks. All patients were clinically evaluated according to the index of performance of Morrey et al. (1993). In addition, a radiological assessment based on the scale of Knirk and Jupiter (1986) for elbow osteoarthritis was performed. The mean follow-up was 9 years. The clinical evaluation showed seven excellent results (six cases of type 1 and one case of type 3 with a score of 100 points for each one), two good (type 1 with 80 and 85 points of respective scores) and three fair (two cases of type 1 with 65 and 60 points of respective scores and one case of type 2 with a score of 65 points). The radiological evaluation showed seven elbows of grade 0 (six cases of type 1 and one case of type 3), four elbows of grade 1 (type 1) and one elbow of grade 2 (type 2). Articular coronal fractures of the distal humerus are rare. The classification of Dubberley et al. (2006) [7] is comprehensive and allows inclusion of all varieties of these fractures. In addition, it is the only one that indicates the surgical approach according to the fracture type. However, to do so, a preoperative CT-scan is highly recommended. The more the fracture line extends medially to involve the trochlea (types 2 and 3), the less a lateral approach is sufficient and the more a combined lateral and medial or a posterior transolecranon approach is mandatory. An internal fixation using conventional small fragment screws inserted from posterior to anterior is feasible when the articular fragment has a sufficient subchondral bone thickness. A direct anteroposterior fixation is better achieved using headless screws buried beneath the cartilaginous surface; it is particularly helpful when the articular fragment has a thin sub-chondral cancellous bone component. Excision is reserved for comminuted fractures, those not amenable to fixation, very thin or osteoporotic fragments, and for the late diagnosed fracture.

Elbow arthrolysis in severely stiff elbows

This study involves the results of open elbow arthrolysis performed on a series of patients having fixed joint contracture. Eighteen patients were treated with open arthrolysis. Eleven patients had very severely stiff elbows (flexion arc less than 30 degrees ), five patients had severely stiff elbows (31 degrees -60 degrees ) and two patients had moderately stiff elbows (60 degrees -90 degrees ). Fixed flexion deformity was observed in nine patients preoperatively.The mean interval between the trauma and arthrolysis was 14.8 months. The mean age was 27 years. After radiological examination, lateral kocher incision was used on 13 patients, medial and lateral incision on 3 patients, transolecranon approach on 1 patient and anterior and posterior approach on 1 patient. External fixator was applied on four patients. Fasia lata interposition was performed in three patients. Additional procedures were as follows, bone fixation in five patients, bone grafting in two patients, nerve grafting in one patient, subcutaneous ulnar nerve transposition in three patients. The average follow-up time was 47 months. At the final evaluation, the mean extension deficit had improved from 55 degrees to 32 degrees . The mean end flexion increased from 81 degrees to 124 degrees postoperatively. The flexion arc of three patients in whom heterotopic ossification was excised had increased to 65 degrees . Infection was diagnosed in two patients (11%). The importance of this study is that the patients have fixed deformities and a long follow-up time. Severely stiff elbow is one of the main indications of open arthrolysis in the patients without muscle atrophy. We suggest sequential arthrolysis as an effective way to obtain good range of motion especially in severe stiff elbows as well as to maintain the ligamantous stability of the elbow joint.

Surgical management of intercondylar fractures of the humerus using triceps reflecting anconeus pedicle (TRAP) approach

Background:Operative fixation of intra-articular fractures of the distal humerus requires adequate exposure. The transolecranon approach is a commonly used approach. The olecranon osteotomy has potential complications related to prominence/migration of hardware, displacement/nonunion of osteotomy and triceps weakness. Triceps-reflecting anconeus pedicle (TRAP) approach avoids the olecranon osteotomy without compromising the operative exposure. We present outcome of fixation of displaced intra-articular distal humeral fractures with the use of TRAP approach.Materials and Methods:We reviewed the functional and radiological results of 40 consecutive patients with intercondylar fractures of the humerus treated by internal fixation through TRAP approach. There were 28 males and 12 females and the average age was 32 ± 4.5 years. The right elbow was involved in 27 patients and the left elbow in 13 patients. The mechanism of injury was a fall in 20 patients, a motor-vehicle accident in 16 patients and direct trauma in four patients.Results:At a minimum follow-up of 12 months (average 18 ± 4 months) 35 (87.5%) patients had good triceps strength. The average range of motion was 118.4 ± 7 degrees (range 80°-130°). The average time to union was 3.2 ± 1.6 months (range two to six months). No patient had triceps rupture, implant failure, neurovascular deficit or nonunion. Two patients needed removal of the implant because of subcutaneous prominence.Conclusions:The TRAP approach provides good visualization for fixation of intercondylar fractures of the humerus, without any noticeable untoward effect on triceps strength and postoperative rehabilitation; and one can avoid iatrogenic fracture of the olecranon and its associated complications.

The Anconeus Flap Transolecranon Approach to the Distal Humerus

The transolecranon approach for the treatment of distal humerus fractures and nonunions is commonly used. A complication of the standard osteotomy is denervation of the anconeus muscle, which provides dynamic stability to the lateral side of the elbow by preventing varus and posterolateral rotatory instability. This article describes the anconeus flap transolecranon (AFT) approach, which utilizes an internervous plane to preserve the anconeus muscle and a chevron-shaped osteotomy for maximal joint exposure. The approach is straightforward to perform with limited complications.

원위 상완골 분쇄 골절의 수술적 치료 결과

Purpose: To report the results of surgical treatment of comminuted fractures of distal humerus and to identify factors that affect the results. Materials and Methods: Thirty-two patients who were treated with open reduction and internal fixation for comminuted fracture of distal humerus were enrolled. According to the AO classification, A2.3 was 1 case, A3.2, 2 cases, A3.3, 8 cases, B1.3, 1 case, B2.3, 1 case, C2.2, 5 cases, C2.3, 4 cases, C3.2, 3 cases and C3.3, 7 cases. As fixation technique, 17 cases were fixed by double plates, 4 cases by only K-wires, 4 cases by only screws, 3 cases by K-wires and screws and 4 cases by one plate and screws. The mean age at the time of the operation was 49 years(range, years). The mean follow-up period was 16 months(range, months). Results: At the last follow-up, the mean maximum flexion was and the mean loss of terminal extension was . The average Mayo elbow performance score was . Overall 29 cases(91%) showed good to excellent results. The mean range of motion of extraarticular and intraarticular fracture group was and , respectively. The average elbow score of both groups was and . Over 90% showed more than good results. 30 cases(94%) showed complete bony union but two cases, nonunion. One case of the nonunion cases underwent replating with bone graft as revision surgery and total elbow arthroplasty was performed in the other case. At the last follow-up, 27 patients(84.4%) showed subjective satisfaction. Conclusion: Open reduction and internal fixation with appropriate surgical technique for comminuted fractures of distal humerus showed good results, which were not affected by age at the time of operation, fixation methods and anterior transposition of the ulnar nerve. Transolecranon approach may be considered as good choice for intraarticular comminuted fractures of distal humerus.

Clinical Outcome of Surgical Treatment of Distal Humerus Intercondylar Fractures Through the Transolecranon Approach Combined with Anterior Transposition of the Ulnar Nerve

Purpose: To analyze the clinical outcomes of surgical treatment of distal humerus intercondylar fractures through the transolecranon approach combined with anterior transposition of the ulnar nerve. Materials and Methods: Eight patients who had distal humerus intercondylar fractures were included in this study and underwent operative treatment through the transolecranon approach for sufficient operative field with anterior transposition of the ulnar nerve and fixed with reconstruction plate. Results: The results were evaluated using Riseborough and Radin rating criteria. Seven cases of eight cases were achieved good results with flexion contracture less than 30 degrees and forward flexion more than 115 degrees. However, one case was acheived poor result with 40 degrees of flexion contractue and 70 degrees of forward flexion. There were no the compressive ulnar neuropathy. Conclusion: We found the transolecranon approach and anterior transposition of the ulnar nerve a viable option for surgical treatment of the distal humerus intercondylar fractures.

Treatment of Supracondylar or Intercondylar Fracture of Humerus in Adult

Distal humerus fracture, particularty those that involve the articular surface, in adult has remained one of the most difficult of all fractures to manage. The goal of this study is to analyze clinical result according to fracture pattern and method of treatments and to recognize complicating factor affecting prognosis. Nonoperatively managed intraarticular fractures are likely to have compromised functional outcome. Open anatomic reduction and stable fixation secure enough to permit early functional, pain-free motion of the elbow showed best result. Stable fixation of fracutre is achieved with use of single or dual plates with additional lag screws depending on the fracture pattern. When there is segmental articular fragments, interfragmentary bipolar threaded screw(Herbert screw) may be useful. Autogenous cancellous bone grafting is sometimes advisable when the diaphyseal portion of the fracture is comminuted. Transolecranon approach affords excellent surgical exposure of the joint surface for fracture with comminuted intra-articular component and there was no postoperative complication.

Comparison between Transolecranon Approach and Posterior Approach in Comminuted Intercondylar Fracture of the Distal Humerus

Comparison between Transolecranon Approach and Posterior Approach in Comminuted Intercondylar Fracture of the Distal Humerus

Surgical Treatment of Comminuted Distal Humerus Intercondylar Fracture in Adult using Transolecranon Approach and AO method

Surgical Treatment of Comminuted Distal Humerus Intercondylar Fracture in Adult using Transolecranon Approach and AO method

Synovectomy and Débridement of the Elbow in Rheumatoid Arthritis

In 1963 a technique for complete synovectomy and appropriate debridement of the elbow joint through a transolecranon approach was developed. Twenty-eight synovectomies and debridements of the elbow joint were carried out in twenty-six patients with rheumatoid arthritis. The minimum follow-up was one