Distal humeral osteotomy combined with posterior olecranon osteotomy approach for coronal shear fracture of the distal humerus: a case report

• DOI: 10.1016/j.xrrt.2022.12.005
• Publication Date: 2023-01-07T23:31:34Z
• Authors: Keisuke Ishizaka; Koji Moriya; Kohei Yamamoto; Yoshiyuki Matsuyama; Hisao Koda; Naoto Tsubokawa
• Keywords: Posterior approach; 03 medical and health sciences; Coronal shear fracture of the distal humerus; 0302 clinical medicine; RD1-811; Distal humeral osteotomy; Surgery; Case Report

The surgical approach for open reduction and internal fixation (ORIF) of coronal shear fractures the distal humerus depends on multiple factors including fracture pattern, extent articular involvement, rehabilitation protocols, associated soft tissue injury, surgeon preference.14Pollock J.W. Athwal G.S. Steinmann S.P. Surgical exposures fractures: a review.Clin Anat. 2008; 21: 757-768https://doi.org/10.1002/ca.20720Crossref PubMed Scopus (29) Google Scholar Common approaches include extensile lateral approach,17Ruchelsman D.E. Tejwani N.C. Kwon Y.W. Egol K.A. Open capitellar with headless screws.J Bone Joint Surg Am. 90: 1321-1329https://doi.org/10.2106/JBJS.G.00940Crossref (74) anterolateral approach,5Imatani J. Morito Y. Hashizume H. Inoue Internal end by approach.J Shoulder Elbow Surg. 2001; 10: 554-556Abstract Full Text PDF (43) posterior olecranon osteotomy approach,2Coles C.P. Barei D.P. Nork S.E. Taitsman L.A. Hanel Bradford Henley M. osteotomy: six-year experience in treatment intraarticular humerus.J Orthop Trauma. 2006; 20: 164-171https://doi.org/10.1097/00005131-200603000-00002Crossref (151) several studies have recently reported medial approach,19Yoshida S. Sakai K. Nakama Matsuura Okazaki Jimbo et al.Treatment capitellum trochlea using compression screws combination dorsolateral locking plates.Cureus. 2021; 13: e13740https://doi.org/10.7759/cureus.13740Crossref epicondyle osteotomy,10Li Martin V.T. Su Z.W. Li D.T. Zhai Q.Y. Yu B. Lateral humerus: Report three cases review literature.World J Clin Cases. 9: 4318-4326https://doi.org/10.12998/wjcc.v9.i17.4318Crossref (4) disruption collateral ligament complex (LCLC)1Chang A.L. Dieterich J.D. DiPrinzio E.V. Kim J.M. techniques intra-articular fracture.Tech Hand Up Extrem 2020; 25: 25-29https://doi.org/10.1097/BTH.0000000000000301Crossref (2) Scholar,16Ring D. an apparent extended exposure.J 2009; 34: 739-744https://doi.org/10.1016/j.jhsa.2009.01.026Abstract (24) to treat humerus. We introduce double (the olecranon) wall comminution. A 60-year-old woman presented emergency department after she accidentally fell from ladder. Radiographs computed tomography scan revealed capitellar, trochlear, epicondylar comminution condyle, anterior fragments were greatly displaced proximal direction (Fig. 1, B). ORIF was performed 12 days following initial injury. opted use approach; thus, patient placed right decubitus position under general anesthesia. After osteotomy, triceps muscle reflected proximally, we attempted reduce through ulnohumeral joint. These could not be observed directly due large displacement direction. In order visualize these fragments, humeral 2A). 2 cm fossa. fragment mobilized laterally, part turned clockwise while making intact as pivot point 2B). There no periosteal attachments trochlea; therefore, assembled back table screw. reduced fixed other screws. All screw heads buried beneath surface. site stabilized provisionally cerclage wires, followed definitive plate posterolateral its support addition wires. Finally, osteotomized tension band wire cannulated immobilization splint four weeks, began active range motion exercises. When clinical radiographic evidence union evident, strengthening exercises initiated. Twelve months surgery, had minimal elbow pain 30° 130° flexion, 70° pronation, 90° supination. complete bony without arthritic changes osteonecrosis 3).Figure 3Plain radiographs taken twelve surgery showed or trochlea.View Large Image Figure ViewerDownload Hi-res image Download (PPT) are many options such excision,4Grantham S.A. Norris T.R. Bush D.C. Isolated capitellum.Clin Relat Res. 1981; : 262-269PubMed ORIF,11McKee M.D. Jupiter J.B. Bamberger H.B. Coronal 1996; 78: 49-54Crossref (221) arthroscopic fixation,8Kuriyama Kawanishi Yamamoto Arthroscopic-assisted percutaneous report two cases.J 2010; 35: 1506-1509https://doi.org/10.1016/j.jhsa.2010.05.021Abstract (40) total arthroplasty6Kamineni Morrey B.F. Distal treated noncustom replacement. technique.J 2005; 87 Suppl 1: 41-50https://doi.org/10.2106/JBJS.D.02871Crossref Scholar; however, is considered gold standard providing anatomical stable initiation early exercises.15Ring Gulotta L. Articular 2003; 85: 232-238https://doi.org/10.2106/00004623-200302000-00008Crossref (197) limited window makes it difficult obtain allow motion. To achieve good outcomes, essential choose suitable that provides direct visualization facilitates fragments.10Li Olecranon most surface just over 50% exposure. Wu al access 46% surface.22Wu Z.Z. Wang Ji X.X. Ma Z.J. J.H. Q.G. exposure study anterior, posterior, approaches.Chin Traumatol. 2018; 356-359https://doi.org/10.1016/j.cjtee.2018.07.006Crossref (7) used when there trochlear condyle.3Dubberley Faber K.J. Macdermid J.C. Patterson S.D. King G.J. Outcome fractures.J 88: 46-54https://doi.org/10.2106/JBJS.D.02954Crossref This can provide widest surfaces humerus; even if passively flexed fullest possible. Thus, supplementary procedures obtaining adequate this been osteotomy10Li release LCLC.1Chang LCLC released condyle humerus, decreased blood supply may potentially cause rotatory instability capitellum.12O’Driscoll S.W. Acute, recurrent, chronic instabilities.in: Orthopaedic knowledge update: shoulder 2. American Academy Surgeons, Rosement, IL2002: 313-323Google proposed prevent disadvantages humerus.10Li also believe osteosynthesis more reliable than repair reattachment LCLC. patient, combined acquire surfaces, because determined stripping required expose proximally via alone. An place viable option. full different windows. easier fix one windows osteotomy. poses risk nonunion metaphysis 3-4 olecranon, so-called watershed area, endured significantly lower density arterial vessels per cancellous bone compared regions.7Kimball J.P. Glowczewskie F. Wright T.W. Intraosseous 2007; 32: 642-646https://doi.org/10.1016/j.jhsa.2007.02.019Abstract (53) Scholar,21Wegmann Burkhart Koslowsky T.C. Koebke Neiss W.F. Müller L.P. Arterial humerus.Surg Radiol 2014; 36: 705-711https://doi.org/10.1007/s00276-013-1240-zCrossref (14) Minimal periosteum perforation should carried out performing option make oblique rigid lag If at nonunion, elderly osteoporosis, low-intensity pulsed ultrasound anabolic agent parathyroid hormone romosozumab. “Good excellent outcomes expected majority patients fracture.9Lee J.J. Lawton J.N. 2012; 37: 2412-2417https://doi.org/10.1016/j.jhsa.2012.09.001Abstract (25) 60 years older highly comminuted has high traumatic arthritis. Excision employed less risk, but fraught complication leads instability, particularly involved.18Yari S.S. Bowers N.L. Craig M.A. Reichel L.M. Management fractures.World 2015 16; 3: 405-417https://doi.org/10.12998/wjcc.v3.i5.405Crossref Although arthroplasty select deemed unrepairable, only short-term functional available deteriorate time.13Pogliacomi Schiavi P. Defilippo Corradi Vaienti E. Ceccarelli al.Total results 65 age.Acta Biomed. 2016; 87: 148-155PubMed Moreover, long-term complications loosening, periprosthetic fractures, deep infections challenging treat.20Watson Bellringer Phadnis current concepts technique.Shoulder Elbow. 12: 124-135https://doi.org/10.1177/1758573219826529Crossref (12) Scholar” best our knowledge, previous novel better LCLC; necessary accompanied like patient. enables conversion very pattern Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association classification system, type B fracture, into C fracture. requires repairs double-plate fixation, simultaneously aspect condyle. first documented case approach. Based management experience, useful However, considering short follow-up period, additional high-quality research verify validity intervention.