Management of intra-articular fractures of distal humerus with two column fixation with orthogonal plate construct

Accurate reconstruction of articular surface of distal humerus by closed manipulation is not possible. The recent trend for displaced intra-articular fractures of the distal humerus is open reduction and stable osteosynthesis with early rehabilitation. We hypothesized that the best exposure of both columns and articular surface of the distal humerus is achieved through trans-olecranon approach and fixation of two columns of intra-articular fracture of distal humeruswith orthogonal plate construct would allow excellent stability and good healing to restore early elbow joint function. 40 cases of intra-articular fractures of distal humerus were treated by open reduction and internal fixation (ORIF) with orthogonal plate construct via transolecranon approach. Chevron type olecranon osteotomy was performed and fixed with tension band wiring in all cases. Periodical radiological evaluationand regular clinical examination were done as per Mayo elbow Performance score. All fractures united within average duration of 3 months. More than 1000 of range of motion is attained in 70% of cases with mean motion of arc of 115(0). The mean Mayo Elbow Performance Score was 90.25 indicating excellent results with mild impairment. The critical factors for a successful outcome of intra-articular fractures of the distal humerus depends upon meticulous surgical technique, stable internal fixation, surgical experimentation and early controlled postoperative mobilization. ORIF with orthogonal plate construct securing both humeral columns via transolecranon approach results in excellent healing by maintaining functional arc of motion.