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Speaker: Consider olecranon osteotomy for distal humeral fractures
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ISTANBUL — In the management of complex elbow fractures, orthopaedic surgeons must consider the surgical approach and rigid internal fixation.
"On the whole, we must be thinking about rigid internal fixation with early mobilization. If you don’t do that, there is a strong risk the elbow will become stiff," David Stanley, MBBS BSc, FRCS, said at the EFORT Congress.
The surgical approaches for distal humeral fractures include olecranon osteotomy, triceps splitting and triceps reflecting, he said.
David Stanley
"If I could give one piece of advice only it would be to say to you that if you are doing these cases, you should nearly always consider olecranon osteotomy. It will give you the greatest exposure to the articular surface. But even if you do the approach, you still will have difficulty getting to the anterior third," he said.
Stanley said his published studies indicate that olecranon osteotomy is the best approach.
"You don’t need to do it if you think you can fix the fractures. But these fractures are often more complicated than you anticipate even if you have done the imaging beforehand" he said.
Because failure occurs at the supracondylar level, orthopaedic surgeons should maximize fixation of distal fragments, he said. Fixation in distal fragments contributes to supracondylar stability.
Stanley said every screw should pass through a plate in the management of distal fragments. Additionally, every screw should be anchored in a fragment on the opposite side fixed by a plate. Surgeons should place as many screws as possible in the distal fragments.
Every screw should be as long as possible and should engage as many articular fragments as possible, he said. The screws in the distal fragments should lock together by interdigitation.
In the reconstruction of complex elbow fractures, Stanley said plates must be applied with compression at the supracondylar level. Additionally, plates must resist bending or breakage before union occurs.
"I would suggest to you that fixing that with this type of plate helps you get it right, helps you to reconstruct it, and helps you get a reasonable result," he said.
Reference:
Stanley D. Elbow fractures: Reconstruction of complex elbow fractures. Presented at: EFORT Congress. 5-8 June 2013; Istanbul.
Disclosure: Stanley has no relevant financial disclosures.