Transcondylar distal humerus fractures are usually high energy comminuted difficult fractures, technically difficult to manage. Anatomic reduction, rigid fixation and early motion are desirable, if technically possible. There are a variety of techniques for fixation. Here, Herbert screws were used to secure the two central purely osteochondral fracture fragments to each other and to the proximal humerus. |
Click on each image for a larger picture |
81 year old physically active woman sustained a left elbow fracture in a syncope related fall. |
Lateral and central fracture component displacement. |
Unusual contour visible at the medial metaphyseal flare. |
This is seen on the lateral view to be the anterior half of the central articular surface. |
This is the fracture pattern: lateral and central column - Anterior view: |
The central column is additionally split into an anterior (blue) and posterior (green) fracture fragments. |
View from below. |
Lateral view. |
Later in the case, the small medial osteochondral fragment was secured with absorbable sutures (not shown). |
Screws were secured from the central articular component to the more proximal humeral cortices. |
These provided biplanar fixation, eventually with two screws in each direction. |
The lateral column was then secured with two cannulated screws. |
The olecranon osteotomy was closed with a 6.5 mm lag screw and (belt and suspenders) tension band technique. |
Anatomic reduction. |
She began immediate protected motion and discontinued splint use at two weeks, despite recommendations to the contrary. These films are two months postop: |
Lateral column not yet fully consolidated on Xray, but clinically healed. |
Flexion: |
Extension: |
Two months postop, standing in front of the same office door: |
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