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Abstract
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Background:
The incidence of distal intra-articular fractures of the humerus is 2% in the adult population and even less in the pediatric population. Especially in pediatric population the misdiagnosis of intra-articular lesions is frequent and conservative treatment may evolve into malunion.
If left untreated, the natural history is characterized by early arthrosis. Posttraumatic intra-articular malunion of the distal humerus represents a major challenge when considering its surgical reconstruction. Few cases are described in the literature.
Methods:
We included 3 consecutive patients, treated with corrective osteotomy for distal articular humerus malunion. The patients underwent the surgical reconstruction at 9, 15 and respectively 37 months after the initial trauma. The age at the time of the osteotomy was 26, 13 and 16 years old. The patients were followed postoperatively for 31 and 28 months, latest case being operated 2 weeks before the study began. The initial injuries were treated conservatively in all patients. The average preoperative arc motion was 102, 125 and 120 degrees.
Results:
Due to the fact that the third patient was operated short before the study started, we’ll present the clinical outcomes of the first two patients. The clinical and radiological outcomes were satisfactory with a postoperative arc of elbow motion of 150 and 135 degrees. The patients could return to all their daily and sport activities without any limitations. No osteoarthritic changes were seen on the postoperative x-rays. One patient presented a delayed wound healing after the initial intervention probably due to the tension at the surgical site. Later on, the same patient underwent a partial implant removal and cubital nerve release due to the discomfort.
Conclusion: This case emphasizes the importance of adequate initial management of intra-articular distal humerus fractures. Surgical reconstruction of a malunited distal humerus fracture is technically challenging, but can improve function and relieve pain in the young active adult by restoring intrinsic anatomy of the elbow.
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