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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2015; 3(5): 405-417
Published online May 16, 2015. doi: 10.12998/wjcc.v3.i5.405
Management of distal humeral coronal shear fractures
Shahram S Yari, Nathan L Bowers, Miguel A Craig, Lee M Reichel
Shahram S Yari, Nathan L Bowers, Miguel A Craig, Baylor College of Medicine, Medical School, One Baylor Plaza, Houston, TX 77030, United States
Lee M Reichel, Baylor College of Medicine, Department of Orthopedic Surgery, Ben Taub General Hospital, Houston, TX 77030, United States
Author contributions: For the first three authors, contributions to writing, reviewing, and editing the article are in the order presented, with Yari SS making the largest contribution, followed by Bowers NL and then Craig MA; all authors contributed to this manuscript.
Conflict-of-interest: The authors of the manuscript did not receive funding, grants, or in-kind support in support of the research or the preparation of the manuscript. The authors do not have any association or financial involvement with any organization or commercial entity having a financial interest in or financial conflict with the subject matter or research presented in the manuscript. All authors, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lee M Reichel, MD, Baylor College of Medicine, Department of Orthopedic Surgery, Ben Taub General Hospital, 1504 Taub Loop, 5B Orthopedic Surgery, Houston, TX 77030, United States. leereichel@gmail.com
Telephone: +1-713-8733363 Fax: +1-713-8732075
Received: July 29, 2014
Peer-review started: July 30, 2014
First decision: October 28, 2014
Revised: January 30, 2015
Accepted: February 9, 2015
Article in press: February 11, 2015
Published online: May 16, 2015
Processing time: 283 Days and 0 Hours
Abstract

Coronal shear fractures of the distal humerus are rare, complex fractures that can be technically challenging to manage. They usually result from a low-energy fall and direct compression of the distal humerus by the radial head in a hyper-extended or semi-flexed elbow or from spontaneous reduction of a posterolateral subluxation or dislocation. Due to the small number of soft tissue attachments at this site, almost all of these fractures are displaced. The incidence of distal humeral coronal shear fractures is higher among women because of the higher rate of osteoporosis in women and the difference in carrying angle between men and women. Distal humeral coronal shear fractures may occur in isolation, may be part of a complex elbow injury, or may be associated with injuries proximal or distal to the elbow. An associated lateral collateral ligament injury is seen in up to 40% and an associated radial head fracture is seen in up to 30% of these fractures. Given the complex nature of distal humeral coronal shear fractures, there is preference for operative management. Operative fixation leads to stable anatomic reduction, restores articular congruity, and allows initiation of early range-of-motion movements in the majority of cases. Several surgical exposure and fixation techniques are available to reconstruct the articular surface following distal humeral coronal shear fractures. The lateral extensile approach and fixation with countersunk headless compression screws placed in an anterior-to-posterior fashion are commonly used. We have found a two-incision approach (direct anterior and lateral) that results in less soft tissue dissection and better outcomes than the lateral extensile approach in our experience. Stiffness, pain, articular incongruity, arthritis, and ulnohumeral instability may result if reduction is non-anatomic or if fixation fails.

Keywords: Coronal; Shear; Fractures; Distal; Humerus; Management; Approach; Two-incision

Core tip: Coronal shear fractures of the distal humerus are rare, complex fractures that can be technically challenging to manage. Distal humeral coronal shear fractures may occur in isolation, may be part of a complex elbow injury, or may be associated with injuries proximal or distal to the elbow. This article aims to summarize the classification, evaluation, management (including surgical approaches, techniques, and post-operative care), and complications of these complex fractures as well as give recommendations on the management.