1. Dpt. Of Traumatology KC LJUBLJANA Distal intraarticular humerus fractures Cimerman Matej Dpt. for Traumatology Univ. Clinical Centre Ljubljana, Slovenia

2. Dpt. Of Traumatology KC LJUBLJANA facts distal humerus fractures remain one of the most demanding challenges in orthopedic and trauma surgery (Korner, J Orthop Trauma 2004, Soon, Injury 2004) distal humerus fractures in adults are rare (2-6% of all fractures) unsatisfactory results in 20% (Jupiter and Morrey, 1993)

3. Dpt. Of Traumatology KC LJUBLJANA solution... every senior trauma and orthopedic surgeon should know to treat basics of these fractures and should know and respect his limits every big trauma center needs some monomaniacs

4. Dpt. Of Traumatology KC LJUBLJANA † dr.Korošec Branko

5. Dpt. Of Traumatology KC LJUBLJANA treatment of articular fractures (we know everything)...anatomical reduction and stable fixation metaphyseal defects should be grafted to prevent articular displacement metaphyseal and diaphyseal displacement should be reduced to prevent joint overloading immediate motion (AO, Shatzker 1987)

6. Dpt. Of Traumatology KC LJUBLJANA easy to say, difficult to realize small bone fragments a lot of elderly people with osteopenic bone difficult approach elbow joint hates even short immobilization long lever arms

7. Dpt. Of Traumatology KC LJUBLJANA classification: AO Mueller B1B2 B3 B: “partial articular” (like partial pregnant)

8. Dpt. Of Traumatology KC LJUBLJANA classification: AO Mueller C1C2C3 C: complete articular

9. Dpt. Of Traumatology KC LJUBLJANA imaging AP standard views CT and 3D

10. Dpt. Of Traumatology KC LJUBLJANA imaging

11. Dpt. Of Traumatology KC LJUBLJANA surgical anatomy 15° P A A P M L

12. Dpt. Of Traumatology KC LJUBLJANA positioning lateral decubitus prone

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14. Dpt. Of Traumatology KC LJUBLJANA approach posterior with olecranon osteotomy (with identification or transposition of ulnar nerve) posterior triceps splitting “V” triceps aponeurosis flap paratricipital posterior approach anconaeus flap extensile approach lateral approach medial approach

15. Dpt. Of Traumatology KC LJUBLJANA olecranon osteotomy Chevron osteotomy, Korošec chissel, oscilating saw and chissel

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18. Dpt. Of Traumatology KC LJUBLJANA triceps splitting

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21. Dpt. Of Traumatology KC LJUBLJANA reduction and fixation strategy reducing and fixation of joint components coupling to methaphisys

22. Dpt. Of Traumatology KC LJUBLJANA implants DCP 3,5mm plates are golden standard 1/3 small tubular plates for radial column LC DCP 3,5mm plates precontoured plates both plates posterior right angle config

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29. Dpt. Of Traumatology KC LJUBLJANA do not be afraid of ulnar nerve

30. Dpt. Of Traumatology KC LJUBLJANA ulnar nerve identification is necessary complete visualization and transposition only if necessary

31. Dpt. Of Traumatology KC LJUBLJANA postop active exercise under the control a soon as possible

32. Dpt. Of Traumatology KC LJUBLJANA complications stiffness: arthrolysis, salvage procedures non union: refixation, TEP infection ulnar nerve paresis: revisions

33. Dpt. Of Traumatology KC LJUBLJANA conclusions respect the fracture and your limits olecranon osteotomy for C type fractures 3.5 mm reco plates golden standard LC 3.5mm reco plates, 1/3 tubular plates and precontoured plates identify ulnar nerve stable fixation mandatory endoprosthesis as an option