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Orthopaedics
Fracture of the Distal Humerus
Built from Tang — Orthopaedic Trauma Vol 1: Upper Extremity
What’s inside
11 sections · 105 slides
Why the Elbow Is Unforgiving
What is at stake and how this deck is organised
- What you will learn
- A rare fracture with heavy consequences
- Why elbow function matters so much
- One of the body's most complex joints
Applied Anatomy
Reading the elbow from the outside in
- Elbow bony landmarks: the three-point relationship
- Surface landmarks you can feel
- Normal elbow range of motion
- How far the elbow should move
- Three-column theory of the distal humerus
- The three-column mental model
- The two side columns
- The trochlea: the keystone
- Articular anatomy: fossae and valgus angle
- Three fossae, three jobs
- Vertical vs parallel plate fixation
- Two ways to plate the columns
- The elbow as a hinge joint
- Anteversion and the tuning-fork geometry of the elbow
- Forty-degree forward tilt of the distal humerus
- Why the joint tilts forward
- Trochlear axis and the carrying angle
- The carrying angle explained
How the Elbow Stays Stable
The restraints you must not destroy
- What stabilizes the extended elbow
- Stability with the elbow straight
- What stabilizes the flexed elbow
- Stability with the elbow bent
- Side-to-side (valgus/varus) stabilizers
Mechanisms of Injury
Two energy stories, two patient groups
- How the fracture happens
- Fracture pattern follows the force
Classifying the Fracture
Naming the injury to plan the surgery
- AO classification: Type A extra-articular fractures
- AO Type B: partial intra-articular fractures
- AO Type C: complete intra-articular fractures
- The AO classification in plain terms
- Bryan & Morrey classification of capitellar fractures
- Bryan & Morrey: the capitellum shear fractures
- David Ring classification: five building blocks
Assessing the Injured Elbow
Examination and imaging
- Clinical assessment
- Never skip the neurovascular check
- Standard X-ray views of the distal humerus
- Making sense of the X-rays
- The fat pad sign: a red flag for hidden fractures
Deciding to Operate
Indications, goals, and timing
- Who needs surgery and why
- Timing the operation
Positioning and Surgical Approach
Getting to the fracture safely
- Patient positioning: lateral decubitus
- Posterior incision surface marking
- Position and incision
- Choosing the approach
- Triceps-split (Campbell) posterior approach
- Triceps-on (Alonso-Llames) approach
- Triceps flip-out (Bryan-Morrey) approach
- Comparing the posterior approaches
- The triceps tongue-flap approach (why it is avoided)
- The olecranon 'bare area' for osteotomy
- Ulnar olecranon osteotomy approach
- Olecranon osteotomy: the widest joint exposure
Reduction and Internal Fixation
Turning three columns back into one bone
- Temporary K-wire fixation of the articular surface
- Parallel plate: the guiding principles
- Rebuilding the joint surface first
- Provisional plate fixation with a sliding-hole screw
- Distal fragment fixation on both columns
- Eccentric compression across the supracondylar fracture
- Interlocking distal screws completing fixation
- The parallel-plate fixation sequence
- Parallel-plate fixation of a Type C1 fracture (case)
- Reconstructing the articular surface with screws
- Vertical plate: reconstructing the surface
- Vertical dual reconstruction-plate fixation
- Type C fracture: anatomical locking plates (case)
- Placing anatomical locking plates on both columns
- Vertical plate: connecting surface to shaft
- Type C3 comminuted fracture: vertical plating (case)
- Coronal-plane (Type B3) shear fractures
- Headless-screw fixation of a capitellar shear
- Coronal capitellar fracture: case radiographs
- Combined column and coronal fracture fixation (case)
- Fixing coronal fractures: front-to-back screws
- Protecting the ulnar nerve at closure
- Closing the wound
Recovery and Complications
Protecting the result you built
- Early motion after dual-plate fixation (case)
- Postoperative rehabilitation
- Primary elbow replacement (case)
- When to replace rather than fix
- Bone shortening for supracondylar bone loss
- Preventing and managing complications
Bringing It Together
The essentials to remember
- Distal humerus fractures by the numbers
- Three ideas that run through this chapter
- Why must trochlear width be restored precisely during fixation of a distal humeral fracture?
- Take-home messages
- References (1/4)
- References (2/4)
- References (3/4)
- References (4/4)
- Orthopaedic Trauma Surgery - Volume 1: Upper Extremity