Open Reduction and Internal Fixation for Lateral Unicondylar Distal Humeral Fractures.

Abstract

Unicondylar distal humeral fractures are uncommon, partially intra-articular fractures (OTA/AO type B1) that are among the most complex fractures to treat^1,2; however, most displaced distal humeral fractures, including lateral unicondylar distal humeral fractures^2-5, can be effectively managed with open reduction and internal fixation. Perform sterile preparation, have the patient brought into the operating room, induce anesthesia, and place the patient in the lateral decubitus or supine position before sterile draping. Make a lateral incision, expose the lateral distal part of the humerus, identify the ulnar nerve if necessary, visualize the fracture fragments, and debride the fracture site. Reduce the fracture and fix it temporarily. Determine the plate length; position the plate posterolaterally, posteriorly, or laterally; insert screws; remove provisional Kirschner wires; and obtain intraoperative images. Make anteroposterior and lateral radiographic images to confirm reduction and adequate anatomic alignment of the elbow and the position of the hardware. Deflate the tourniquet, irrigate the wound, and apply postoperative dressings. The detailed outcome for a cohort of 24 patients who underwent this procedure has been reported elsewhere⁶.