Arthroscopic-assisted Open Reduction and Internal Fixation of AO-ASIF Type C Distal Humeral Fractures

摘要

The olecranon osteotomy has long been the gold-standard approach to enable visualization and permit fixation of displaced intra-articular distal humeral fractures. It is, however, associated with known complications including failure of fixation and reoperation for removal of prominent hardware. We have developed a dry arthroscopic-assisted technique that provides adequate visualization to enable fixation without the need for olecranon osteotomy. Inclusion criteria were Association for Osteosynthesis/Association for the Study of Internal Fixation (AO-ASIF) type C fractures. Exclusion criteria were fractures deemed not reconstructable on preoperative traction computed tomography, thus requiring hemiarthroplasty or total elbow arthro-plasty. Eight consecutive patients (28 to 83 y) with AO-ASIF type C were selected. In this series, no fracture was considered for arthroplasty. A standard posterior midline incision was made. The posterior joint capsule was incised. The intra-articular fragments were exposed and fixed outside the joint to create 2 main fragments and 1 main fracture line. The fragments were then reduced under dry arthroscopic vision, and fixed with standard compression plating techniques. All fractures were successfully treated with this technique. Adequate fixation was judged on arthroscopic evaluation and intraoperative image intensifier. Some difficulty was encountered in elderly patients with crush components to the central fragments. Dry arthroscopic-assisted open reduction and internal fixation is a useful tool in the treatment of AO-ASIF C type fractures. It eliminates the complications of olecranon osteotomy and once the operator is familiar with the technique it may also reduce the operative time.