This Instructional Course is meant to be an addendum to previous courses, supplementing them with a review of a series of eighteen comminuted fractures of the distal end of the humerus. In the past two years I have tried to use the information obtained in this study. Open reduction and internal fixation was the treatment of choice whenever possible and thus far I have no regrets. I tried the transolecranon posterior approach and found it helpful in re-establishing the relationship of the condyles to each other and to the ulna. Elbow motion after operation was started at approximately seven to ten days and some loss of position was noted when fixation was not secure. Hence, I have become more cautious in pressing for early motion when there is any doubt as to the security of fixation.
This lecture calls attention to the variance of opinion concerning treatment of supracondylar and intercondylar fractures of the humerus in the adult. Closed reduction and traction have not proved adequate for the treatment of this fracture and have not given the best functional result. Open reduction appears to be most advantageous when all other factors are favorable.
Since the survey was conducted, several more open reductions have convinced me of the advantages of this procedure. The primary objective was to secure strong enough fixation to permit early motion of the elbow. Advanced age of a patient should not be a strong deterrent when considering open reduction as treatment. Even extensively comminuted fractures can be improved, and the patient thus can be given a better chance to have more function and use of the elbow. If security of fixation is not anticipated, the treatment of choice should be traction combined with early motion.
Copyright 1964 by The Journal of Bone and Joint Surgery, Incorporated