Lateral epicondyle osteotomy approach for coronal shear fractures of the distal humerus: Report of three cases and review of the literature

Abstract

BACKGROUND Coronal shear fractures of the distal humerus are rare injuries and are technically challenging to manage. Open reduction and internal fixation (ORIF) has become the preferred treatment because it provides anatomical reduction, stable internal fixation, and early motion, but the optimal surgical approach remains controversial. CASE SUMMARY We report three cases of coronal shear fractures of the distal humerus treated successfully by ORIF via a novel surgical approach, in which lateral epicondyle osteotomy was performed based on the extended lateral approach. We named the novel surgical approach the lateral epicondyle osteotomy approach. All patients underwent surgical treatment and were discharged successfully. All patients had excellent functional results according to the Mayo elbow performance score. The average range of motion was 118° in flexion/extension and 172° in pronation/ supination. Only case 2 had a complication, which was implant prolapse. CONCLUSION We demonstrated that the lateral epicondyle osteotomy approach in ORIF is effective and safe for coronal shear fractures of the distal humerus.

Coronal Shear Fractures of the Distal Humerus

“…Additionally, by raising the LUCL origin off the bone, the joint can be hinged open to allow for better exposure of the medial trochlea, while preserving the olecranon and medial soft tissues. In certain cases, the lateral epicondyle is fractured and the joint can be exposed by simple mobilization of the fragment, with the LUCL remaining attached to the bone [ 49 ]. Whenever the LUCL or the lateral epicondyle is detached, it needs a careful reinsertion, with either suture anchors or bone tunnel fixation, in order to avoid posterolateral rotatory instability.…”

The lateral combined approach for coronal shear fractures of the distal humerus with intact lateral epicondyle

“…In our experience the intact or not intact lateral epicondyle is a crucial factor in the operative treatment for coronal fracture of distal humerus. If the epicondyle is intact, osteotomy could be performed and re ected anteriorly to expose the anterior compartment, which could be named as epicondyle osteotomy approach [9]. In addition, the fractured epicondyle could be re ected directly which could be named as natural epicondyle osteotomy approach.…”

“…So the selection of an appropriate surgical approach is necessary. The most commonly reported approach is lateral approach or its extensile variations [9,[18][19][20]. In these reports the common extensors or even the LUCL were stripped off the lateral epicondyle as full thickness sleeve and retracted anterior to expose the fractures.…”

“…Exposure of the distal humeral articular surface for internal xation is challenging for the surgeons owing to its unique anatomy. Several approaches for this lesion including the anterolateral approach [4], extended lateral approach [5], posterior olecranon osteotomy approach [2,[6][7][8], and lateral epicondyle osteotomy approach [9] have been reported. Among these the lateral approach is typically used for the fractures as Dubberley classi cation subtype A fractures [2], in which the interval between the extensor digitorum communis and extensor carpi radialis longus/brevis tenotomy proximally could be used to expose the anterior compartment of the elbow [10].…”

Distal humeral osteotomy combined with posterior olecranon osteotomy approach for coronal shear fracture of the distal humerus: a case report

“…The surgical approach for open reduction and internal fixation (ORIF) of coronal shear fractures of the distal humerus depends on multiple factors including fracture pattern, extent of articular involvement, rehabilitation protocols, associated soft tissue injury, and surgeon preference. 14 Common approaches include the extensile lateral approach, 17 anterolateral approach, 5 and posterior olecranon osteotomy approach, 2 and several studies have recently reported a medial approach, 19 lateral epicondyle osteotomy, 10 and disruption of lateral collateral ligament complex (LCLC) 1 , 16 to treat complex coronal shear fractures of the distal humerus.…”