Evaluation and treatment of open distal humeral fractures
COPYRIGHT © 2017 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED. » The complex anatomy of the distal aspect of the humerus, in combination with the challenge of treating the traumatized soft-tissue envelope, addressing bone and articular cartilage loss, and minimizing postoperative complications, often leads to suboptimal outcomes following the treatment of open distal humeral fractures. » The overall goals of treatment should focus on rigid fixation, maintaining or restoring a viable soft-tissue envelope, restoring functional range of motion, and limiting complications. » Although uncommon, some open distal humeral fractures are associated with concomitant injuries and are associated with complex fracture patterns involving the entire articular surface. » The initial treatment of an open distal humeral fracture includes tetanus prophylaxis and the administration of antibiotics followed by excisional debridement to reduce the risk of infection. » Multiple operative fixation strategies have been used, including external fixation, internal fixation, and total elbow arthroplasty, each of which may be better suited for particular patients and fracture patterns. » For large soft-tissue defects, the early use of soft-tissue procedures to provide adequate and stable wound coverage can result in improved outcomes and fewer complications.
Zimmer, Z., Horneff, J., Taylor, R., Levin, L., Kovach, S., & Mehta, S. (2017). Evaluation and treatment of open distal humeral fractures. JBJS Reviews, 5 (1). http://dx.doi.org/10.2106/JBJS.RVW.16.00024