Instructional Course Lecture   |    
Distal Humeral Fractures: Role of Internal Fixation and Elbow Arthroplasty
Joaquin Sanchez-Sotelo, MD, PhD1
1 Department of Orthopaedic Surgery, Gonda 14, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address: sanchezsotelo.joaquin@mayo.edu
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Look for this and other related articles in Instructional Course Lectures, Volume 61, which was published by the American Academy of Orthopaedic Surgeons in February 2012:

“Ligament Injury and the Use of Hinged External Fixators at the Elbow,” by Bernard F. Morrey, MD

Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, was available in February 2012 in Instructional Course Lectures, Volume 61. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).

Disclosure: The author received no payments or services, either directly or indirectly (i.e., via his institution), from a third party in support of any aspect of this work. Neither the author nor his institution has had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, the author has not had any other relationships, or engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Mar 21;94(6):555-568. doi: 10.2106/JBJS.946icl
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The management of distal humeral fractures has evolved over the last few years. Worldwide application of the AO principles of plate and screw fixation during the late 1980s and early 1990s remained the only breakthrough for quite some time1. Recent major advancements in the management of these injuries include the widespread availability of computed tomography (CT) scans with three-dimensional reconstruction, recognition of the more complex articular shear fractures2, understanding the benefits of the parallel-plate technique3, the availability of precontoured periarticular plates, and the selective use of total elbow arthroplasty4. Opportunity for improvement remains, as reflected by the interest in distal humeral hemiarthroplasty for the treatment of these injuries and the controversy regarding the ideal management of the ulnar nerve as a part of this surgery and how to best manage structural bone loss. Unfortunately, insufficient internal fixation with Kirschner wires continues to be performed by some surgeons, greatly compromising patient outcome.
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