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Surgical Elbow Dislocation Approach to the Distal Humerus for Apparent Capitellar and Lateral Condyle Fractures in Adults.

OBJECTIVES
Access to fractures of the distal humeral capitellum, trochlea, and lateral condyle is difficult via traditional approaches due to limited anterior articular exposure for direct reduction and fixation. The purpose of this study is to evaluate the relative articular exposure of a surgical dislocation (SD) approach to the distal humerus compared to olecranon osteotomy (OO).


METHODS
Eight paired elbows from four cadavers underwent either SD or OO approach. Methylene blue staining demarcated visualized articular surface before disarticulation of the elbows. The main outcome measures were average visualized total distal humeral articular surface, anterior and posterior surface, and capitellar surface relative to the total surfaces was compared for each surgical approach using unpaired parametric t-tests.


RESULTS
Intraclass correlation between raters was 0.995. The median exposed articular surface for SD and OO approaches was 90.0% and 62.8%, respectively. The overall exposure was significantly greater for the dislocation technique (p=0.0003). With respect to specific regions of the distal humeral articular surface, SD allowed significantly greater visualization of the anterior surface (95.9% versus 48.9%, p<0.0001) and capitellum (100% versus 40.4%, p<0.0001).


CONCLUSION
The surgical elbow dislocation approach to the distal humerus permits near total exposure of the anterior articular surface and the entire capitellum. Our data supports this approach for anterior articular fractures of the distal humerus, to include those fractures that extend to the medial surface of the trochlea.