Distal Humerus Open Reduction Internal Fixation
There have been considerable advances in the treatment of distal humerus fractures that allow for better outcomes. The widespread use of computed tomography helps surgeons preoperatively plan the method of fixation best suited for each patient. Modern fixation techniques are designed to improve mechanical stability of the construct through pre-contoured periarticular plates and the use of interlocking screws, or screws that lock into the plates.
These designs allow for better fixation and improved stability in fractures that are often comminuted or have pre-injury poor bone quality. These improvements in fixation have resulted in a decreased rate of hardware failure and nonunion, however the range of motion of the elbow is not reliably restored in every patient. The goal of surgery in distal humerus fractures is to achieve a stable fixation that allows for early unprotected range of motion to prevent the commonly encountered elbow stiffness.
Distal Humerus Fracture Surgery
The procedure most commonly performed for humerus fractures is open reduction internal fixation. This type of fixation includes utilizing plates and screws to approximate the broken bones together so the body can heal the injury faster and with the correct alignment. The location of the injury dictates the surgical approach utilized.
Once the surgeon is able to visualize the two ends of the broken bone, they use removable clamps or wires to hold the bone together in appropriate alignment. The fracture is then fixed utilizing basic principles of fracture fixation known to all orthopaedic surgeons. The plate and screws used to hold the bone together will remain within the body for life and are seldom removed.
Humerus fractures vary in morphology and location which dictate treatment necessary. There are many humeral shaft fractures and proximal humerus fractures that can heal without the need for surgery. After 6-8 weeks patients will often return to their activities of daily living with inconsequential effects from their injury. However, there are also a number of humerus fractures that require operative management to prevent resulting deformities, maintain pre-injury range of motion, and return functional strength to the affected arm.
Distal humerus fractures almost always warrant operative fixation. They occur most commonly in the elderly population after a low energy fall or in the younger population as a result of high energy trauma. Commonly encountered injuries include supracondylar fracture, single or bicolumn fractures, or coronal shear fractures. There may be isolated humerus involvement or include other associated injuries such as elbow dislocation, olecranon fracture, or compartment syndrome. Above all, the most common complaint of patients with distal humerus fractures is the resulting elbow stiffness from their injury.
Each fracture should be considered individually on a case-by-case basis and patients should discuss the various treatment options with their physician.
Given the technical difficulty of fixing elbow fractures and the resultant poor bone quality of these fractures, Stryker released their VariAx 2® elbow locking plate system. Their distal humerus titanium alloy plates are contoured to fit the native anatomy of the elbow. Surgeons can choose between 180-degree or 90-degree plating, which allows for increased options that may be needed depending on fracture morphology. The equipment sets also have plating equipment for the often-concomitant olecranon fractures in the elbow.