Background: Severe comminution, bone loss, and osteopenia at the
site of a distal humeral fracture increase the risk of an unsatisfactory
result, often secondary to inadequate fixation. The purpose of this study was
to determine the outcome of treating these fractures with a principle-based
technique that maximizes fixation in the articular fragments and stability at
the supracondylar level.
Methods: Thirty-four consecutive complex distal humeral fractures
were fixed with two parallel plates applied (medially and laterally) in
approximately the sagittal plane. The technique was specifically designed to
satisfy two principles: (1) fixation in the distal fragments should be
maximized and (2) screw fixation in the distal segment should contribute to
stability at the supracondylar level. Twenty-six fractures were AO type C3,
and fourteen were open. Thirty-two fractures were followed for a mean of two
years. The patients were assessed clinically with use of the Mayo Elbow
Performance Score (MEPS) and radiographically.
Results: Neither hardware failure nor fracture displacement occurred
in any patient. Union of thirty-one of the thirty-two fractures was achieved
primarily. Five patients underwent additional surgery to treat elbow
stiffness. There was one deep infection that resolved without hardware removal
and did not impede union. At the time of the most recent follow-up,
twenty-eight elbows were either not painful or only mildly painful, and the
mean flexion-extension arc was 99°. The mean MEPS was 85 points. The
result was graded as excellent for eleven elbows, good for sixteen, fair for
two, and poor for three.
Conclusions: Stable fixation and a high rate of union of complex
distal humeral fractures can be achieved when a principle-based surgical
technique that maximizes fixation in the distal segments and stability at the
supracondylar level is employed. The early stability achieved with this
technique permits intensive rehabilitation to restore elbow motion.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.