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Distal Humerus Fractures Open Reduction Internal Fixation: Case Presentation and Surgical Technique

February 12, 2016

Contributors: Kenneth A Egol, MD, FAAOS; Carlos Uquillas, MD; Mathew Hamula, BA, BS

Purpose: Fractures of the distal humerus are relatively complex and technically challenging. There is a low threshold for surgical fixation, and a variety of approaches to surgical management exist. Management of the ulnar nerve, in particular, can be challenging. This video demonstrates a chevron osteotomy technique for a posterior approach to distal humeral fractures. Methods: Surgical approaches to distal humeral fractures includes the triceps split, the triceps-reflecting anconeus pedicle approach, triceps reflecting, paratricipital approach, and olecranon osteotomy. The latter is typically carried out using a chevron technique. The osteotomy can be repaired after distal humeral fracture reduction using a plate or tension-band wire technique. Results: This video presents a case of an intra-articular distal humeral fracture necessitating open reduction and internal fixation. We demonstrate the chevron olecranon osteotomy technique of the posterior approach and plating of the distal humeral fracture. Anatomic reduction is achieved with two plates, one each on the medial and lateral columns. Conclusion: Open reduction and internal fixation of distal humeral fractures can challenge orthopaedic surgeons. The chevron olecranon osteotomy provides an effective and reliable approach to intra-articular fragments. Knowledge of this technique can help optimize reduction of fracture fragments.