Purpose
Medial column fractures of the distal humerus are uncommon in adults. Among 26 patients
identified in the English language literature, only 2 had articular fragmentation.
We reviewed the experience of 2 trauma centers with isolated medial column fractures
to evaluate our impression that these fractures often involve complex articular fragmentation.
Methods
There were 10 men and 4 women with an average age of 61 years (range, 44–86 years).
The incidence was 3% of all distal humerus fractures at one institution with a prospective
fracture database. The mechanism of injury was a fall from standing height in most
patients. There was one B2.1 fracture, 3 B2.2 fractures, 9 B2.3 (multifragmentary),
and 1 C3.2 fracture. All patients were treated surgically; 7 were treated with an
olecranon osteotomy. Eight patients had 1 or more postoperative complications and
5 patients underwent subsequent surgeries.
Results
We observed 11 patients for an average of 8 years (range, 14 months to 21 years).
The arc of ulnohumeral motion averaged 92°, average flexion was 118°, and average
flexion contracture was 25°. According to the Broberg and Morrey Functional Rating
Index, the result was excellent in 4 patients, good in 6, and fair in 1. Six patients
had arthrosis (3 grade 1 and 3 grade 2) according to the radiographic criteria of
Broberg and Morrey.
Conclusions
Surgeons should be aware that the relatively uncommon medial column adult distal humerus
fracture usually features complex articular fragmentation, but that satisfactory results
can be obtained after open reduction and internal fixation.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Accepted:
November 19,
2008
Received:
June 6,
2008
Footnotes
The authors are grateful to the AO Documentation Center in Davos, Switzerland, and to Dr. E.L.F.B. Raaymakers for managing the fracture database for the Departments of Orthopaedic Surgery and General Surgery at the Academic Medical Center in Amsterdam, The Netherlands, over the past decades. Four cases included in the study were identified through this database. The authors also thank the Departments of Surgery and Traumatology of the Academic Medical Center of Amsterdam for permission to use data from their patients.
Support was received in the form of unrestricted research grants from AO Foundation, Wright Medical, Joint Active Systems, Smith and Nephew, Small Bone Innovations, Biomet, Acumed, Tornier, and the Doris Duke Fellowship.
Identification
Copyright
© 2009 Published by Elsevier Inc.
