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Management of Arbeitsgemeinschaft fur osteosynthesefragen type C fractures of distal humerus in adults with two column fixation

Manjit S. Daroch, Sanjeev Sreen, Deepak Vashisht, Parveen Puri.

Background: Accurate reconstruction of articular surface of distal humerus by closed manipulation is not possible. The recent trend for displaced intra-articular fractures of the distal humerus is open reduction and stable osteosynthesis with early rehabilitation. The best exposure of both columns of the distal part of the humerus and articular surface is achieved through trans-olecranon approach. Objective of the study was to evaluate the management and outcome of two column fixation of intra-articular fracture of distal humerus in adults by posterior approach via olecanon osteotomy and to restore early elbow joint function.
Methods: Twenty-five cases of intra-articular fractures of distal humerus were treated by open reduction and internal fixation. All the patients were of adult age group. Chevron type olecranon osteotomy was performed and fixed with tension band wiring in all cases and follow-up period was upto 36 months. Regular clinical examination and periodical radiological evaluation were done.
Results: All fractures united within average duration of 3 months. Results were evaluated as per Mayo Elbow Performance Score. According to this criteria, excellent result was achieved in 8 patients (32%), good in 13 (52%), fair in 3 (12%) and poor in 1 (4%) patients. Thus satisfactory result was obtained in 96% cases.
Conclusions: The critical factors for a successful outcome of intra-articular fractures of the distal humerus depend upon severity of fracture, meticulous surgical technique, stable internal fixation, surgical experimentation and early controlled postoperative mobilization.

Key words: Adults, Distal humerus, Olecranon, Posterior approach, Type C fractures

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