Advertisement

Arthroscopic-Assisted Surgery of the Distal Humeral Fractures

  • Selami Cakmak
  • Roza Dzoleva Tolevska
  • Enes Sari
  • Daniela Georgieva
  • Mahir Mahirogullari
Chapter

Abstract

Fractures of the distal part of the humerus are rare in adults, but there has been an increase in their number and incidence among the elderly. Mostly these fractures involve disruption of both the medial and lateral columns, disrupting the humeral triangle and resulting in disassociation of the articular surface from the humeral shaft. The clinical appearance of distal humerus fractures can be described as a painfully swollen elbow with deformity and functional disability.

The fracture specifics, including bone quality, fracture pattern, level of comminution, articular involvement, displacement, and associated injuries, must be understood completely before treatment is performed. Standard anteroposterior and lateral radiographs of the elbow are usually sufficient for diagnosis, classification, and surgical templating.

Due to the complexity of the local anatomy and injury patterns, fractures of the distal humerus are challenging to treat. The stiffness of elbow and devitalization of the bony fragments are other problems with extended surgical exposures. The indications for elbow arthroscopy have expanded with increased experience levels and advances in arthroscopic instrumentation due to high incidence of complications following elbow surgery in experienced hands. Arthroscopic-assisted surgery may be helpful for selected patients in several types of distal humeral fractures including capitellar fractures, lateral condyle fractures, coronal shear fractures of the coronoid, and pediatric distal humeral fractures (epicondylar, supracondylar, or unicondylar fractures) .

Keywords

Elbow fractures Arthroscopy Capitellar fractures Distal humerus 

References

  1. Ashwood N, Verma M, Hamlet M, Garlapati A, Fogg Q (2010) Transarticular shear fractures of the distal humerus. J Shoulder Elbow Surg 19:46–52CrossRefGoogle Scholar
  2. Athwal GS, Goetz TJ, Pollock JW, Faber KJ (2008) Prosthetic replacement for distal humerus fractures. Orthop Clin North Am 39(2):201–212CrossRefGoogle Scholar
  3. Barnes LAF, Parsons BO, Hausman M (2015) Arthroscopic management of elbow fractures. Hand Clin 31:651–661CrossRefGoogle Scholar
  4. Bégué T (2014) Articular fractures of the distal humerus. Orthop Traumatol Surg Res 100(1 Suppl):S55–S63CrossRefGoogle Scholar
  5. Behrman MJ, Shelton ML (1990) Fracture of the medial condyle of the humerus in an elderly patient. J Orthop Trauma 4(1):98–101CrossRefGoogle Scholar
  6. Brouwer KM, Bolmers A, Ring D (2012) Quantitative 3-dimensional computed tomography measurement of distal humerus fractures. J Shoulder Elbow Surg 21:977–982CrossRefGoogle Scholar
  7. Bryan RS, Morrey BF (1985) Fractures of the distal humerus. In: Morrey BF (ed) The elbow and its disorders. WB Saunders, Philadelphia, pp 302–339Google Scholar
  8. Chen RC, Harris DJ, Leduc S, Borrelli JJ Jr, Tornetta P 3rd, Ricci WM (2010) Is ulnar nerve transposition beneficial during open reduction internal fixation of distal humerus fractures? J Orthop Trauma 24(7):391–394CrossRefGoogle Scholar
  9. Cheung EV (2007) Fractures of the capitellum. Hand Clin 23:481–486CrossRefGoogle Scholar
  10. Davies MB, Stanley D (2006) A clinically applicable fracture classification for distal humeral fractures. J Shoulder Elbow Surg 15:602–608CrossRefGoogle Scholar
  11. Dodson CC, Nho SJ, Williams RJ 3rd et al (2008) Elbow arthroscopy. J Am Acad Orthop Surg 16(10):574–585CrossRefGoogle Scholar
  12. Doornberg J, Lindenhovius A, Kloen P, van Dijk CN, Zurakowski D, Ring D (2006) Two and three-dimensional computed tomography for the classification and management of distal humeral fractures. Evaluation of reliability and diagnostic accuracy. J Bone Joint Surg Am 88(8):1795–1801CrossRefGoogle Scholar
  13. Gradl G, Jupiter JB (2012) Current concepts review—fractures in the region of the elbow. Acta Chir Orthop Traumatol Cechoslov 79(3):203–212Google Scholar
  14. Grantham SA, Norris TR, Bush DC (1981) Isolated fracture of the humeral capitellum. Clin Orthop Relat Res (161):262–269Google Scholar
  15. Guitton TG, Doornberg JN, Raaymakers EL, Ring D, Kloen P (2009) Fractures of the capitellum and trochlea. J Bone Joint Surg Am 91:390–397CrossRefGoogle Scholar
  16. Hardy P, Menguy F, Guillot S (2002) Arthroscopic treatment of capitellum fracture of the humerus. Arthroscopy 18(4):422–426CrossRefGoogle Scholar
  17. Hausman M, Panozzo A (2004) Treatment of distal humerus fractures in the elderly. Clin Orthop Relat Res 425:55–63CrossRefGoogle Scholar
  18. Holt MS, Savoie FH, Field LD, Ramsey JR (2004) Arthroscopic management of elbow trauma. Hand Clin 20:485–495CrossRefGoogle Scholar
  19. Hotchkiss RN, Green DP (1991) Fractures and dislocations of the elbow. In: Rockwood CA, Green DP, Bucholz RW (eds) Fractures in adults. JB Lippincott, Philadelphia, pp 739–841Google Scholar
  20. Ilyas AM, Jupiter JB (2008) Treatment of distal humerus fractures. Acta Chir Orthop Traumatol Cechoslov 75(1):6–15Google Scholar
  21. John H, Rosso R, Neff U, Bodoky A, Regazzoni P, Harder F (1994) Operative treatment of distal humeral fractures in the elderly. J Bone Joint Surg Br 76(5):793–796CrossRefGoogle Scholar
  22. Jung SW, Kang SH, Jeong M, Lim HS (2016) Triangular fixation technique for bicolumn restoration in treatment of distal humerus intercondylar fracture. Clin Orthop Surg 8(1):9–18CrossRefGoogle Scholar
  23. Jupiter JB, Mehne DK (1992) Fractures of the distal humerus. Orthop 15:825–833Google Scholar
  24. Jupiter JB, Morrey BF (1993) Fractures of the distal humerus in the adult. In: Morrey BF (ed) The elbow and its disorders. WB Saunders, Philadelphia, pp 328–366Google Scholar
  25. Lee JJ, Lawton JN (2012) Coronal shear fractures of the distal humerus. J Hand Surg Am 37(11):2412–2417CrossRefGoogle Scholar
  26. Leet AI, Young C, Hoffer MM (2002) Medial condyle fractures of the humerus in children. J Pediatr Orthop 22(1):2–7PubMedGoogle Scholar
  27. Marsh JL, Slongo TF, Agel J et al (2007) Fracture and dislocation classification compendium—2007: orthopaedic trauma association classification, database and outcomes committee. J Orthop Trauma 21(10 Suppl):S1–S133CrossRefGoogle Scholar
  28. McKee MD, Jupiter JB, Bamberger HB (1996) Coronal shear fractures of the distal end of the humerus. J Bone Joint Surg Am 78:49–54CrossRefGoogle Scholar
  29. Mehme DK, Jupiter JB (1992) Part II fractures of the distal humerus. In: Browner DD (ed) Skeletal trauma. Saunders, Philadelphia, PA, pp 1146–1153Google Scholar
  30. Milch H (1964) Fractures and fracture-dislocation of the humeral condyles. J Trauma 4:592–607CrossRefGoogle Scholar
  31. Min W, Anwar A, Ding BC, Tejwani NC (2010) Open distal humerus fractures—review of the literature. Bull NYU Hosp Jt Dis 68:257–261PubMedGoogle Scholar
  32. Mitani M, Nabeshima Y, Ozaki A et al (2009) Arthroscopic reduction and percutaneous cannulated screw fixation of a capitellar fracture of the humerus: a case report. J Shoulder Elbow Surg 18:e6–e9CrossRefGoogle Scholar
  33. Muller LP, Kamineni S, Rommens PM, Morrey BF (2005) Primary total elbow replacement for fractures of the distal humerus. Oper Orthop Traumatol 17:119–142CrossRefGoogle Scholar
  34. Nauth A, McKee MD, Ristevski B, Hall J, Schemitsch EH (2011) Distal humeral fractures in adults. J Bone Joint Surg Am 93(7):686–700CrossRefGoogle Scholar
  35. O’Driscoll S, Morrey B, An K (1990) Intraarticular pressure and capacity of the elbow. Arthroscopy 6:100–103CrossRefGoogle Scholar
  36. Palvanen M, Kannus P, Niemi S, Parkkari J (2010) Secular trends in distal humeral fractures of elderly women: nationwide statistics in Finland between 1970 and 2007. Bone 46:1355–1358CrossRefGoogle Scholar
  37. Pollock JW, Faber KJ, Athwal GS (2008) Distal humerus fractures. Orthop Clin North Am 39(2):187–200CrossRefGoogle Scholar
  38. Ring D, Jupiter J, Gulotta L (2003) Articular fractures of the distal part of the humerus. J Bone Joint Surg Am 85(2):232–238CrossRefGoogle Scholar
  39. Riseborough EJ, Radin EL (1969) Intercondylar T fractures of the humerus in the adult. A comparison of operative and non-operative treatment in twenty-nine cases. J Bone Joint Surg Am 51(1):130–141CrossRefGoogle Scholar
  40. Robinson CM, Hill RM, Jacobs N, Dall G, Court-Brown CM (2003) Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma 17(1):38–47CrossRefGoogle Scholar
  41. Rose SH, Melton LJ III, Morrey BF (1982) Epidemiologic features of humeral fractures. Clin Orthop Relat Res (168):24–30Google Scholar
  42. Ruchelsman DE, Tejwani NC, Kwon YW, Egol KA (2008) Coronal plane partial articular fractures of the distal humerus: current concepts in management. J Am Acad Orthop Surg 16:716–728CrossRefGoogle Scholar
  43. Sheehan ES, Dyer SG, Sodickson DA, Patel IK, Khurana B (2013) Traumatic elbow injuries: what the orthopedic surgeon wants to know. Radiographics 33:869–888CrossRefGoogle Scholar
  44. Singh AP, Dhammi IK, Garg V, Singh AP (2012) Outcome of surgical treatment of type IV capitellum fractures in adults. Chin J Traumatol 15:201–205PubMedGoogle Scholar
  45. Sullivan JA (2006) Fractures of the lateral condyle of the humerus. J Am Acad Orthop Surg 14(1):58–62CrossRefGoogle Scholar
  46. Tongel AV, Macdonald P, Riet RV, Dubberley J (2012) Elbow arthroscopy in acute injuries. Knee Surg Sports Traumatol Arthrosc 20:2542–2548CrossRefGoogle Scholar
  47. Watts AC, Morris A, Robinson CM (2007) Fractures of the distal humeral articular surface. Bone Joint Surg Br 89-B:510–515CrossRefGoogle Scholar
  48. Webb LX (2001) Fractures of the distal humerus. Rockwood and Green’s fractures in adults. Lippincott Williams & Williams, Philadelphia, pp 953–972Google Scholar
  49. Wong AS, Baratz ME (2009) Elbow fractures: distal humerus. J Hand Surg Am 34(1):176–190CrossRefGoogle Scholar
  50. Yari SS, Bowers NL, Craig MA, Reichel LM (2015) Management of distal humeral coronal shear fractures. World J Clin Cases 3:405–417CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Selami Cakmak
    • 1
  • Roza Dzoleva Tolevska
    • 2
  • Enes Sari
    • 3
  • Daniela Georgieva
    • 2
  • Mahir Mahirogullari
    • 4
  1. 1.Department of Orthopaedic SurgeryAcibadem Kadikoy HospitalIstanbulTurkey
  2. 2.University Clinic for Orthopedic SurgerySkopjeRepublic of Macedonia
  3. 3.Department of Orthopaedic SurgeryNear East University HospitalTRNC-Mersin 10Turkey
  4. 4.Department of Orthopaedic SurgeryMemorial HospitalIstanbulTurkey

Personalised recommendations