novel surgical approach to the distal humerus combined with osteotomy of the olecranon, which avoids visualization or direct manipulation of the ulnar nerve. The main advantage of his technique lies in subperiosteal elevation of the ulnar nerve together with all structures of the cubital tunnel. In the present study, anatomical dissections of distal humerus structures were performed on a cadaver to define individual steps of the technique introduced by Dr. Korošec. Ten phases of the procedure were identified. Ten patients (4 males and 6 females) with type 13-C and 13-B fractures of the distal humerus (AO/ASIF) were operated on. The patients showed no clinical signs of ulnar nerve injury before surgery. During the operation, the ulnar nerve was electrically stimulated at the axilla and compound muscle action potentials were continuously recorded from hypothenar muscles. Latency and amplitude of the potentials were monitored. Analysis of these data using the unpaired t-test for median values revealed no statistically significant differences between individual stages of the operation (p < 0.00625). An amplitude decrease accompanied by a latency increase by more than 10% over the baseline value was found to indicate impending nerve damage. The novel approach to the distal humerus presented in this article is a safe procedure. 47 patients (49 elbows) which had sustained 21.A3 and 21.C3 fractures were identified and retrospectively studied.There were two broad groups of patients. Young males following high-energy injuries (average age = 38 ± 16) and old females with osteoporotic fractures (average age = 65 ± 17). Twenty-two patients had associated monteggia and seven patients had trans-olacrenon dislocation. Twenty-three patients had radial sided injury. This included two capitular fractures, nineteen radial head and neck fractures and one radial shaft fracture. Forty-five patients were treated with plating and 2 patients were treated with tension band wiring. Five different plating techniques were used to stabilize the fracture.Eighteen patients had incongruent reduction. Eighteen patients had complications of the treatment. There were seven cases of non-union, one case of loss of fixation, three cases of heterotrophic ossification, three cases of synostosis, one case of deep infection and five complications resulting from radial head fractures.There was no relationship between loss of fixation and plating techniques. There was a direct relation between comminution and post fixation incongruency. Heterotrophic ossification was associated with comminution, radial head fracture, monteggia fracture-dislocation and non-union. Radio-ulnar synostosis was associated with comminution of the ulnar fracture.In conclusion, the main predictor of poor outcome is the comminution of proximal ulnar fracture and ability to achieve congruous fracture fixation.
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