Distal Humeral Fracture Fixation with an Extensor Mechanism-on Approach

Open treatment of extra-articular and intra-articular distal humeral fractures can be effectively accomplished through an extensor mechanism-on approach. Assess all images for multiplane fracture lines involving the capitellum or trochlea. Verify with fluoroscopy that the patient and arm positions allow for adequate imaging of the distal part of the humerus. Perform medial and lateral arthrotomies posterior to the collateral ligament complexes and excise the intra-articular fat pad and posterior aspect of the capsule. Reduce the distal humeral fragments anatomically under direct visualization posteriorly and indirectly with fluoroscopy using the intact sigmoid notch as a template for reduction. Place multiple screws distally through the plates medially and laterally; each screw should be of maximal length and engage the opposite column. Remove the dressing on postoperative day two and begin full active-assisted elbow range of motion and grip-strengthening therapy program. In our series of thirty-seven patients , all fractures healed primarily with a median motion arc of 126° (range, 60° to 141°). The median triceps strength loss was 10% (range, 0% to 49%). IndicationsContraindicationsPitfalls & Challenges.