Bryan and Morrey type IV intra-articular fracture of the distal extremity of the humerus treated surgically with anterior access: case report

Abstract

Within the context of elbow-level trauma, fractures with a coronal line at the distal extremity of the humerus are rare and result from indirect axial trauma with the arm extended. These are difficult-to-treat intra-articular fractures, since they require stable anatomical reduction in order to maintain joint congruence and diminish complications such as stiffness. This paper reports a case that occurred in a young man who suffered a fall from a ladder that resulted in a Bryan and Morrey type IV intra-articular fracture of the humerus. The injury was treated surgically by means of an anterior access, using osteosynthesis with two Herbert screws that were inserted from anterior to posterior.

Coronal shear fracture of distal humerus associated with olecranon fracture: A case report and pathomechanism

“…However, open reduction with internal fixation is the mainstream choice for managing coronal shear fractures showing good to excellent outcomes, which is superior to other methods such as fracture excision, arthroscopic reduction and fixation, or total elbow arthroplasty. [1][2][3][4][5]8 Although the lateral extensile approach and fixation are commonly used, [2][3][4]9 in our opinion, the posterior approach may be better in those cases. When the posterior approach is used to expose the coronal shear fragment, a surgical osteotomy to expose the fracture site is mandatory.…”

“…To preserve blood supply and avoid disruption of the posterior soft tissue, many surgeons preferred an anterior-toposterior direction approach to employ the interfragmentary screw and fix the fracture. [2][3][4]9 In these cases, however, considering the already disrupted posterior soft tissue, we fixed the screws in the posterior-to-anterior fashion.…”

“…The "double arc sign," a half-moon shaped, dissociated fragment from the capitellum, appearing on the lateral view Journal of Orthopaedic Surgery 27 (2) of the radiograph is useful for diagnosis. 6 This sign may not be present in all cases 4,10 ; thus, it cannot be the sole diagnostic criterion. Adjuvant three-dimensional CT can assist in determining fracture configuration and in preoperative planning.…”

“…Distal humeral coronal shear fractures are rare and account for around 1% of all fractures at the elbow level and 6% of the distal humeral fractures. [1][2][3][4] The pathomechanism of injuries usually includes axial loading of the capitello-trochlear area by the force transmitted through the radial head from a lowenergy fall or from spontaneous reduction of a posterolateral subluxation or dislocation. [2][3][4][5] Many studies 2,3,5 have reported on the associated injuries, which involve the lateral collateral ligament injuries and radial head fractures in up to 40% and 30% of humeral fractures, respectively, but this combination of coronal shear fracture of the trochlea and capitellum associated with olecranon fracture is unusual.…”

A Complicated Course of a Coronal Shear Fracture Type IV of the Distal Part of Humerus Resulting in Resurfacing Radiocapitellar Joint Replacement

“…Closed reduction, immobilization or fragment excision are generally associated with poor outcomes [ 12 , 15 ]. For ORIF, the use of headless compression screws has proven to be a suitable and reliable option [ 10 , 13 , 17 ]. However, intraarticular migration of a headless compression screw despite complete union of fracture after anatomical reduction, such as in our case, can be a concern.…”