Intraarticular Distal Humerus Fracture

Lee Hunter MD, MBA

Hunter Medical Founder and Chief Medical Officer

December 2017

 

Distal humerus fractures can be challenging cases, primarily due to the inherent difficulty in positioning the limb to create a stable surgical platform. Supine positioning is optimal and enables excellent surgical exposure of the entire distal humeral articular surface and the majority of the humeral shaft. The ElbowLOC® Arm Positioning System greatly simplifies and expedites these cases by allowing the surgeon to quickly and easily restore humeral length, and thus gross reduction of the fracture with the patient positioned supine.

60 YOF WITH COMMINUTED DISTAL HUMERUS FRACTURE

The patient sustained a terribly comminuted distal humerus fracture as shown below. She has a history of MS, but remains very active. Given her relatively young age and activity level, surgical repair of her fracture as opposed to joint replacement was recommended.

The Procedure

   The patient was positioned supine utilizing the ElbowLOC® Arm Positioning System. A standard posterior approach was made, along with an olecranon osteotomy. The distal half of the humeral shaft was exposed in the usual manner. The fragments of the distal humerus were reduced and provisionally pinned. Thereafter, two 90/90 plates were applied. The fracture healed uneventfully, with ROM 20> 130 degrees and full forearm rotation by 3 months postop.

The Reducer/Distractor component of the ElbowLOC® allows the surgeon to rapidly restore normal humeral length and thus obtain (and maintain) gross reduction of the fracture. This ability greatly simplifies and expedites the surgery as the surgeon can now “fine tune” the reduction, provisionally stabilize the fracture, and then apply the definitive fixation. In my experience, supine positioning using the ElbowLOC® Arm Positioning System can reduce procedural times (as compared to lateral decubitus or prone positioning) literally in half for these difficult cases.

This case is another great example of how the ElbowLOC® simplifies and accelerates procedural times for many elbow surgeries and makes surgery easier for the surgeon, patient, and staff!

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