The Surgical Outcomes of the Articular Shear Fractures of the Distal Part of the Humerus

Background: Coronal shear fractures of the distal humerus have recently been identified as a “new” type of fracture. Ring and colleagues proposed a classification for this fracture with 5 increasingly complex subtypes. The purpose of this retrospective study is to classify the patterns of articular shear fractures of the distal part of the humerus, according to Ring’s classification, and to analyze the results of the surgical treatments. Method: Thirteen patients with a mean age of 59 (15-88) years underwent operative treatment and were then followed for an average of 21 (12-30) months. All but 2, treated with total elbow arthroplasty, underwent open reduction and internal fixation (ORIF). Results: According to Ring’s classification, there were three type 2, two type 3, five type 4, and three type 5. Average Mayo Elbow Performance Score was 85 (60-100): 5 patients had excellent, 4 had good, and 4 had fair results. Fracture union was achieved in all but 1. The average arc of motion was 103 with an average flexion contracture of 19. In the analysis of the ORIF group, the patients presenting fracture of the posterior aspect of the lateral column showed worse results than those that were not. It was the same for the patient presenting fracture of the posterior trochlea. A precise recognition of these fracture patterns is useful in surgical decision making and choice of surgical technique. Our results suggest that the type of fracture involvement with posterior aspect of trochlea or capitellum can make poor clinical outcomes.