Razi Journal of Medical Sciences

    Background and Aim: Intra-articular fractures of distal humerus in adults present a controversial challenge for orthopedic surgeons. Minor irregularities of the joint surface of the elbow usually cause some loss of function. This can usually be minimized by early, accurate open reduction with sufficiently rigid fixation to permit immediate motion. The posterior approach combined with Olecranon osteotomy and fixation with the two plates at right angles, a medial plate on the medial column and a posterior plate on the lateral column, is considered the standard of care of displaced intra-articular distal humeral fractures (AO type C). The purpose of this study was to evaluate the results of the treatment of intra-articular fractures of distal humerus.

Patients and Methods: In this descriptive –croos sectional study we evaluated 46 patients (18 females & 28 males) with a mean age of 31.22 years, who had intra-articular fractures of distal humerus (Type C1- 17 and C2 & C3-17) and were operatively treated between 2000 and 2005. After a standard posterior approach with Olecranon osteotomy, internal fixation was achieved with unilateral or bilateral plates and screws. The outcome measured variables were pain scale, range of motion, the ability of daily activities, infections, nerve injuries, radiological assessments (mal:::union:::, non-:::union:::, malalignment, …), joint stiffness, osteoarthritis, recurrent bursitis, instability and need for fixation.�We used the SPSS software for statistical analysis of data. The main indices that we used were frequency and percent.For statistical analysis

Kendall's and Fisher's exact tests were used. p<0.05 was considered as statistically significant.

Results: There was no pain after surgery in 16 patients (34.8%). Mild pain in 17(37%), moderate pain in 11(23.9%) and severe pain was reported in 2(4.3%). The range of motion in 24 patients (52.2%) was more than 100 degree. It was 50 to 100 degree in 18(39.1%) and less than 50 degree in 4(8.7%). The ability to perform�previous daily activity was "as before" in 14 patients (30.4%). It was "partially as before" in 26(56.5%) and "decreased activity" in 6(13%). Superficial infection was detected in only 2 (4.3%). None of the cases had deep infection.Only 2 of patients (4.3%) had ulnar nerve injury. Meanwhile 3 (6.5%) had non :::union:::.

Conclusion: The surgical repair of an intra-articular distal humerus fracture (especially the transolecranon approach for good visualization, routine ulnar nerve exploration and rigid internal fixation) is an effective procedure that permits early rehabilitation in these complicated fractures.