Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Distal Humerus Fractures
Updated: Oct 4 2016

Distal Humerus Fracture ORIF

Preoperative Patient Care
Operative Techniques

Preoperative Plan


Template fracture

  • identify fracture pattern, displacement, comminution, and presence of dislocation


Execute surgical walkthrough

  • describe key steps of the operation verbally to attending prior to beginning of case.
  • description of potential complications and steps to avoid them

Room Preparation


Surgical instrumentation

  • small fragment plates
  • malleable recon plates or precontoured periarticular plates
  • mini fragment plates
  • Herbert screws
  • Kwires
  • sterile tourniquet
  • reduction clamps


Room setup and equipment

  • c-arm perpendicular to OR table


Patient positioning

  • lateral decubitus position
  • place affected extremity over arm bolster
  • arm should be in 90 degrees of flexion
  • pad all bony prominences
  • place sterile tourniquet

Direct Posterior Approach to the Elbow


Mark and start the incision

  • begin 5cm proximal to the olecranon in the midline of the posterior distal humerus
  • curve laterally proximal to the tip of the of the olecranon along the lateral aspect of the olecranon process
  • then curve medially over the middle of the posterior aspect of the subcutaneous ulna


Identify the ulnar nerve

  • palpate the ulnar nerve and fully dissect it out
  • is helpful to pass tape or penrose for identification at all times


Incise fascia

  • incise deep posterior fascia in the midline
  • can either split triceps fascia, or continue with olecranon osteotomy
  • create full thickness flaps to minimize dead space/hematoma

Triceps Sparing Approach


Elevate the triceps

  • lift the triceps directly from the humerus and the intermuscular septum
  • retract the olecranon fragment proximally


Identify radial nerve

  • identify the sensory branch of the radial nerve laterally
  • follow the nerve proximally to identify the radial nerve proper


Divide or dissect the anconeus on its lateral side

  • elevate this with the triceps
  • expose the joint laterally


Alternative procedure olecranon osteotomy

  • drill and tap olecranon prior to osteotomy
  • score the olecranon with an osteotome to allow perfect reduction
  • repair osteotomy
  • V-shaped osteotomy of the olecranon 2 cm from the tip using an oscillating saw

Prepare Fracture and Obtain Articular Congruity


Expose fracture

  • remove any clots from the fracture site


Evaluate the articular surface

  • determine whether the entire articular surface is present

Obtain Provisional Articular Fixation with Kwire


Reduce the articular fragments

  • use the proximal ulna and radial head as templates
  • check the rotational alignment


Perform provisional reduction

  • place two 2.0 mm smooth wires at the medial and lateral condyles for reduction
  • these should be placed through the plates
  • these will be replaced with screws later


Place medial and lateral plates

  • these should be placed so that one of the distal holes of each plate slide over the smooth Kwires
  • place one cortical screw in slotted hole through each plate
  • keep loose so that adjustments to plate can be made

Obtain Definitive Plate Fixation


Place screws

  • place 2 or more screws distally medially and laterally
  • replace the 2 smooth Kwires with distal screws
  • do not drill because of possible fracture


Perform compression

  • perform compression back out the most proximal screw on one side
  • place a large bone clamp distally to that side
  • place bone clamp proximally to the opposite side
  • maintain compression by application of a compression screw
  • follow the same steps for the opposite side


Place remaining screws


Test range of motion of elbow


Wound Closure


Irrigation and hemostasis

  • irrigate wounds thoroughly
  • deflate tourniquet (if elevated)
  • coagulate any bleeders carefully


Deep closure

  • use 0-vicryl for deep closure


Superficial closure

  • use 3-0 vicryl for subcutaneous closure
  • close skin with 3-0 nylon


Dressing and immediate immobilization

  • soft dressing (gauze, webril)
  • long arm anterior splint splint in extension
  • sling for comfort
Postoperative Patient Care
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options