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Background: This study assessed outcomes after treatment of patients with capitellum fracture diagnosed >4 weeks after the trauma (delayed) who presented with stiff elbow., Methods: We reviewed 7 patients with stiff elbows after delayed diagnosis of capitellum fractures between February 2007 and February 2012. They were treated with arthrolysis by twin incisions, late open reduction and internal fixation, and a hinged external fixator. According to the Bryan-Morrey-McKee classification, 3 patients had type I capitellum fractures and 4 patients had type IV., Results: Mean follow-up was 28 months (range, 24-38 months). The mean delay from the initial trauma was 3.7 months. The flexion arc improved from a preoperative mean of 24° to a postoperative mean of 122°. The Mayo Elbow Performance Score increased from a mean of 56 points to 93 points. Anatomic fracture union occurred in all cases, and there was no secondary displacement., Conclusions: Arthrolysis, late internal fixation, and use of a hinged external fixator can solve problems associated with stiff elbow after delayed diagnosis of capitellum fracture. Combined use of these techniques may be a safe and effective treatment option., (Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Displaced comminuted of the distal humerus in adults are among the most complex fractures to be managed effectively. The ulnar nerve is at high risk of impingement secondary to injury, operation, and postoperative rehabilitation in these fractures. In this study we focus on the incidence, management, and prognosis of early ulnar nerve dysfunction in the course of treating type C fractures of distal humerus., Methods: We examine a patient sample of 117 consecutive AO type C fractures of distal humerus, between June 1998 and October 2005. Twenty-nine patients exhibited preoperative ulnar nerve compression symptoms (incidence 24.8%) and were divided into two groups randomly, which received treatment of anterior subfascial transposition or in situ decompression of the ulnar nerve respectively, in conjunction with internal fixation with medial and lateral plates., Results: The subgroup of 88 patients without preoperative ulnar nerve symptoms remained asymptomatic postoperatively (0% incidence of late ulnar nerve dysfunction). According to Bishop rating system, excellent and good results of ulnar nerve function were achieved in 13 of 15 patients (86.7%) in the transposition group, 8 of 14 patients (57.1%) in the in situ decompression group. The results difference is statistically significant (p < 0.05)., Conclusions: We conclude that neurolysis and anterior subfascial transposition of vascularized ulnar nerve during open reduction and internal fixation of type C fractures of the distal humerus is beneficial in cases of early ulnat nerve dysfunction.

Background: Although several studies reported good results of open reduction and internal fixation of displaced fracture of the adult distal humerus, few studies have specifically addressed the results of such surgical fixation in osteoporotic bone in the elderly., Methods: This study focused on AO type C fractures in the elderly by using 2 plates for fixation of the lateral and medial columns to reconstruct a stable triangular frame of the distal humerus. The study comprised 35 patients, and 32 were available for final evaluation at a mean follow-up of 24.5 months (range, 14-60 months)., Results: Mayo Elbow Function Score showed 25 patients (78%) achieved an excellent functional result, and 7 (22%) had a good result. No patients were considered to have a fair or poor result. At the final follow-up, the mean range of flexion to extension of the elbow was 22 degrees (range, 10 degrees -40 degrees) to 125 degrees (range, 100 degrees -140 degrees). All fractures united at average of 3.5 months (range, 2.5-5.3 months)., Conclusion: Open reduction and internal fixation using double-columned plating is a useful and effective technique in the management of displaced, comminuted, intra-articular fractures of the distal humerus in elderly patients., Level of Evidence: Level 4; Case series, treatment study.

Although several treatment options for radial head fractures are available, no clear solutions exist. In this study we therefore compare open reduction and internal fixation (ORIF) with bipolar radial head prosthesis replacement in treatment of radial head fractures of Mason type III. Cement stem and bipolar radial prosthesis were used to treat 12 fresh cases and two old cases of Mason type III radial head fracture. As a control group, another eight cases of radial head type III fracture were treated with ORIF with cannulated screws and Kirschner (K) wires. The 14 patients who received radial head prosthesis replacement were followed-up for 15.9 months (range 10-27 months). According to elbow functional evaluation criteria by Broberg and Morrey, we found excellent results in nine cases, good in four, and fair in one. Mean follow-up of the eight cases in the ORIF group was 14 months (range 10-21 months), with good results in one case, fair in four, and poor in three. The result was good or excellent in 92.9% of prosthesis replacement patients and in 12.5% of ORIF patients. This difference is statistically significant (P = 0.0004; Fisher's exact test). We concluded that bipolar radial head prosthesis replacement is better than ORIF in treatment of Mason type III radial head fracture.