The Treatment and Functional Outcome of Type IV Coronal Shear Fractures of the Distal Humerus: A Retrospective Review of Five Cases

• Published in: Journal of orthopaedic trauma Vol. 17; no. 4; pp. 279 - 284
• Main Authors: Stamatis, Emmanouil, Paxinos, Odysseas
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-04-2003; Lippincott Williams & Wilkins
• Subjects: Adult; Biological and medical sciences; Bone Screws; Female; Follow-Up Studies; Fracture Fixation, Internal; Humans; Humeral Fractures - diagnostic imaging; Humeral Fractures - physiopathology; Humeral Fractures - surgery; Medical sciences; Middle Aged; Orthopedic surgery; Outcome Assessment (Health Care); Radiography; Recovery of Function - physiology; Retrospective Studies; Shear Strength; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Trauma Severity Indices; Human; Coronal shear fracture; Prognosis; Diseases of the osteoarticular system; Internal; Osteosynthesis; Lower extremity; Fracture; Trochlea of humerus; Trauma; Distal humerus; Orthopedic surgery; Fixation; Treatment; Screw; Herbert screw; Upper limb; Humeral condyle; Bone; Technique; Humerus; Elbow
• ISSN: 0890-5339; 1531-2291
• DOI: 10.1097/00005131-200304000-00006

OBJECTIVETo present the treatment method and outcome of 5 cases of type IV coronal shear fractures of the distal end of the humerus.
DESIGNRetrospective study.
PATIENTSFive patients with an isolated type IV coronal shear fracture of the distal end of the humerus.
INTERVENTIONOpen reduction and internal fixation of the fractures utilizing Herbert screws, through a modified extensile lateral Kocher approach.
MAIN OUTCOME MEASUREMENTSFunctional elbow index rating scale of Broberg-Morrey, Mayo Elbow Performance Score, subjective satisfaction rate and subjective functional limitations, and radiographic evaluation of the operated elbows for the presence or absence of osteonecrosis and degenerative joint disease changes.
RESULTSThe follow-up time ranged from 39 to 50 months. All fractures healed within 6 to 9 weeks. The latest radiographic evaluation revealed mild degenerative joint disease changes in 1 patient and osteonecrosis of the coronal shear fragment in another. None of the patients reported pain even during strenuous activities, and none had clinical findings or subjective complaints suggesting instability of the elbow joint. Four patients regained full range of elbow motion compared with the contralateral elbow, and only 1 had a 10° extension lag. The muscle strength of the major muscle groups of the operated elbow was equal to that of the uninjured elbow when tested clinically. No patient reported limitations in activities, and all indicated complete satisfaction with their outcome. According to the Broberg-Morrey scale and the Mayo Elbow Performance Score, all results were excellent, with scores ranging from 98 to 100 points.
CONCLUSIONSRecognition of this particular type of injury, prompt treatment with anatomic reduction and internal fixation, and early rehabilitation can lead to excellent functional outcomes.