Minimally Invasive Methods for Adolescent Intraarticular Distal Humerus Fractures with an Intact Column
Location
LSUHSC-NO Center for Advanced Learning and Simulation
Document Type
Presentation
Start Date
21-6-2025 8:45 AM
End Date
21-6-2025 9:05 AM
Publication Date
June 2025
Description
Introduction: Intraarticular distal humerus fractures can occur in adolescents and represent a unique morphology that is amenable to different surgical techniques than distal humerus fractures in adults or younger children, especially when one column remains intact. Despite articular involvement, a minimally invasive approach utilizing the intact periosteum and opposing intact column of bone can often achieve successful reduction and fixation. Here, we present operative techniques that we have found helpful for these fractures.
Key Concepts: Intraarticular distal humerus fractures occur in adolescents and often demonstrate a characteristic pattern with a relatively vertical intraarticular fracture line with minimal articular comminution and limited displacement. Excellent reduction and fixation can often be accomplished through minimally invasive or percutaneous techniques, unlike most intraarticular distal humerus fractures in adults. In this paper, we describe straightforward fracture reduction methods, including indirect reduction via guide pins and cannulated screws alone or augmented with a periarticular clamp or ball-spike pusher. Our preferred fixation technique involves lateral-to-medial screws, ideally with one screw just proximal to the articular surface and additional screws as needed proximal to the olecranon fossa.
Conclusion: Intraarticular distal humerus fractures in adolescents behave differently than intraarticular fractures in adults, often displaying less displacement due to intact periosteum. In these fractures, minimally invasive fixation with percutaneous lag screws is a viable option for cases without articular comminution. This technique can provide adequate stability, early transition from immobilization post-operatively and avoidance of open plating techniques. The surgical technique is well-grounded in orthopaedic principles, including using periosteum to facilitate reduction in growing patients and favoring a less-invasive approach when possible.
Recommended Citation
Broussard, Austin MD, "Minimally Invasive Methods for Adolescent Intraarticular Distal Humerus Fractures with an Intact Column" (2025). Dept. of Orthopaedics: Robert D. D’Ambrosia Lectureship & Research Day. 2.
https://digitalscholar.lsuhsc.edu/ortho_rd/2025/presentation1/2
Minimally Invasive Methods for Adolescent Intraarticular Distal Humerus Fractures with an Intact Column
LSUHSC-NO Center for Advanced Learning and Simulation
Introduction: Intraarticular distal humerus fractures can occur in adolescents and represent a unique morphology that is amenable to different surgical techniques than distal humerus fractures in adults or younger children, especially when one column remains intact. Despite articular involvement, a minimally invasive approach utilizing the intact periosteum and opposing intact column of bone can often achieve successful reduction and fixation. Here, we present operative techniques that we have found helpful for these fractures.
Key Concepts: Intraarticular distal humerus fractures occur in adolescents and often demonstrate a characteristic pattern with a relatively vertical intraarticular fracture line with minimal articular comminution and limited displacement. Excellent reduction and fixation can often be accomplished through minimally invasive or percutaneous techniques, unlike most intraarticular distal humerus fractures in adults. In this paper, we describe straightforward fracture reduction methods, including indirect reduction via guide pins and cannulated screws alone or augmented with a periarticular clamp or ball-spike pusher. Our preferred fixation technique involves lateral-to-medial screws, ideally with one screw just proximal to the articular surface and additional screws as needed proximal to the olecranon fossa.
Conclusion: Intraarticular distal humerus fractures in adolescents behave differently than intraarticular fractures in adults, often displaying less displacement due to intact periosteum. In these fractures, minimally invasive fixation with percutaneous lag screws is a viable option for cases without articular comminution. This technique can provide adequate stability, early transition from immobilization post-operatively and avoidance of open plating techniques. The surgical technique is well-grounded in orthopaedic principles, including using periosteum to facilitate reduction in growing patients and favoring a less-invasive approach when possible.
Comments
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