Brouwer Kim M, Guitton Thierry G, Doornberg Job N, Kloen Peter, Jupiter Jesse B, Ring David
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.
J Hand Surg Am. 2009 Mar;34(3):439-45. doi: 10.1016/j.jhsa.2008.11.022.
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.
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.
We observed 11 patients for an average of 8 years (range, 14 months to 21 years). The arc of ulnohumeral motion averaged 92 degrees, average flexion was 118 degrees, and average flexion contracture was 25 degrees. 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.
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.
