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Distal intraarticular humerus fractures

Distal intraarticular humerus fractures. Cimerman Matej Dpt. for Traumatology Univ. Clinical Centre Ljubljana, Slovenia. facts. distal humerus fractures remain one of the most demanding challenges in orthopedic and trauma surgery (Korner, J Orthop Trauma 2004, Soon, Injury 2004)

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Distal intraarticular humerus fractures

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  1. Distal intraarticular humerus fractures Cimerman Matej Dpt. for Traumatology Univ. Clinical Centre Ljubljana, Slovenia

  2. facts • distal humerus fractures remain one of the most demanding challenges in orthopedic and trauma surgery (Korner, J Orthop Trauma 2004, Soon, Injury 2004) • distal humerus fractures in adults are rare (2-6% of all fractures) • unsatisfactory results in 20% (Jupiter and Morrey, 1993)

  3. solution... • every senior trauma and orthopedic surgeon should know to treat basics of these fractures • and should know and respect his limits • every big trauma center needs some monomaniacs

  4. † dr.Korošec Branko

  5. treatment of articular fractures (we know everything) • ...anatomical reduction and stable fixation • metaphyseal defects should be grafted to prevent articular displacement • metaphyseal and diaphyseal displacement should be reduced to prevent joint overloading • immediate motion (AO, Shatzker 1987)

  6. easy to say, difficult to realize • small bone fragments • a lot of elderly people with osteopenic bone • difficult approach • elbow joint hates even short immobilization • long lever arms

  7. classification: AO Mueller B: “partial articular” (like partial pregnant) B3 B1 B2

  8. classification: AO Mueller C: complete articular C1 C2 C3

  9. imaging • AP standard views • CT and 3D

  10. imaging

  11. surgical anatomy A M L A P P 15°

  12. positioning lateral decubitus prone

  13. approach • posterior with olecranon osteotomy (with identification or transposition of ulnar nerve) • posterior triceps splitting • “V” triceps aponeurosis flap • paratricipital posterior approach • anconaeus flap extensile approach • lateral approach • medial approach

  14. olecranon osteotomy Chevron osteotomy, Korošec chissel, oscilating saw and chissel

  15. triceps splitting

  16. reduction and fixation strategy • reducing and fixation of joint components • coupling to methaphisys

  17. implants • DCP 3,5mm plates are golden standard • 1/3 small tubular plates for radial column • LC DCP 3,5mm plates • precontoured plates • both plates posterior • right angle config

  18. do not be afraid of ulnar nerve

  19. ulnar nerve • identification is necessary • complete visualization and transposition only if necessary

  20. postop • active exercise under the control a soon as possible

  21. complications • stiffness: arthrolysis, salvage procedures • non union: refixation, TEP • infection • ulnar nerve paresis: revisions

  22. conclusions • respect the fracture and your limits • olecranon osteotomy for C type fractures • 3.5 mm reco plates golden standard • LC 3.5mm reco plates, 1/3 tubular plates and precontoured plates • identify ulnar nerve • stable fixation mandatory • endoprosthesis as an option

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