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Articular Fractures of the Distal Part of the Humerus

Investigation performed at the Hand Surgery Service, Massachusetts General Hospital, Boston, Massachusetts

David Ring, MD
Jesse B. Jupiter, MD
Lawrence Gulotta, BA
Hand Surgery Service, Massachusetts General Hospital, ACC 525 (D.R.) and 527 (J.B.J. and L.G.), 15 Parkman Street, Boston, MA 02114. E-mail address for D. Ring: dring{at}partners.org

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the AO Foundation. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The purpose of this retrospective study was to identify the patterns of distal humeral articular fractures and to analyze the results of open reduction and internal fixation of these injuries.

Methods: The cases of twenty-one patients with an articular fracture of the distal part of the humerus were reviewed at an average of forty months after the injury. Five components of the injury were identified: (1) the capitellum and the lateral aspect of the trochlea, (2) the lateral epicondyle, (3) the posterior aspect of the lateral column, (4) the posterior aspect of the trochlea, and (5) the medial epicondyle. All fractures were reduced and were stabilized with implants buried beneath the articular surface.

Results: All fractures healed, and no patient had residual ulnohumeral instability or weakness. Ten patients required a second operation: six, for release of an elbow contracture; two, for treatment of ulnar neuropathy; one, for removal of hardware causing symptoms; and one, because of early loss of fixation. The average arc of ulnohumeral motion was 96° (range, 55° to 140°). The results according to the Mayo Elbow Performance Index were excellent in four patients, good in twelve, and fair in five.

Conclusions: Apparent fractures of the capitellum are often more complex fractures of the articular surface of the distal part of the humerus. Treatment of these injuries with operative reduction and fixation with buried implants can result in satisfactory restoration of elbow function.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Intructions to Authors for a complete description of levels of evidence.

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