Hybrid Fixation of Open Distal Humerus Fracture With Acute Loss of Lateral Articular Condyle

Abstract

Acute, major articular bone loss associated with an open fracture is an uncommon injury. These injuries typically occur after high-energy trauma and are challenging to treat. Various approaches to treatment include allografts, prosthetic composite structures, custom implants, and total joint arthroplasty. These treatment options provide a wide array of variability in outcomes, costs, and challenges, especially in young and active patients. Two patients presented to our institution with open elbow injuries that included structural bone loss of the lateral column including the entire capitellar articular surface and a portion of the lateral trochlea. With the limited portions of bone available, the surgical principles for distal humerus fracture of articular repair followed by medial and lateral column restoration were followed. Each patient was treated with repair of the residual remnant of the articular surface. Then, repair of the columns of the distal humerus was performed by using a combination of internal fixation and hinged external fixation. In both cases, a plate was inserted to repair the medial column and a hinged external fixation was applied laterally to protect the lateral column. Immediate motion was allowed and progressed within each patient's tolerance. The lateral, hinged external fixator was removed at 8 weeks after injury and converted to a lateral column plate fixed distally into the lateral portion of the residual trochlea. At follow-up, both patients had radiographic evidence of reconstitution of the lateral column of the distal humerus and were able to return to heavy manual labor. [ Orthopedics . 2022;45(3):e162–e167.]