210. LONG-TERM RESULTS OF SURGICAL TREATMENT OF MEDIAL CONDYLE FRACTURES OF THE HUMERUS IN ADULTS

Abstract

Purpose of the study: Fracture of the medial condyle of the humerus is uncommon in adults. The purpose of this retrospective analysis was to examine the clinical and radiographic outcomes of a single-site series.

Material and methods: From January 1990 to December 2004, nine closed fractures of the medial condyle of the humerus were treated surgically in seven men and two women, mean age 31.22 years (range 16–65). No vessel or nerve injury was noted at diagnosis. According to the AO/ASIF classification, all fractures were type B2. Surgery was undertaken on day 2 to 6, via a medial or posterior approach for pin or screw fixation. Postoperatively, the joint was held immobile with a brace for 5.57 weeks (3–8.). Functional and physical outcome were studied using the Mayo Clinic Elbow Performance score. Bone healing and secondary osteoarthritis were assessed on plain x-rays.

Results: Six patients were reviewed at mean follow-up of 9.31 years (4.31–16.56), three patients were lost to follow-up. There were no infections. Four patients experienced sensorial disorders in the territory of the ulnar nerve including three with persistent symptoms at last follow-up. Two elbows were slightly painful at last follow-up. Two patients aged 16 and 18 years at trauma exhibited exaggerated valgus. Material was removed for three patients. Mean flexion was 123.83 (90–140), mean extension deficit 3.33 (−10 to 0), mean pronation 82.5 (70–85), mean supination 90, the flexion-extension range 122.16 (90–130). The Mayo Elbow Performance Score was 89.16 (65–100), one patient was dissatisfied, three patients exhibited moderated joint impingement. Hypertrophy of the medial condyle was noted in three patients. All fractures healed.

Discussion: These fractures are rare in adults. Few series are reported in the literature, with small populations. The mechanism of the injury can be direct shock on a flexed elbow or indirect shock by fall onto the hand. Valgus deviation and hypertrophy of the medial condyle in adolescents appear to be secondary to secondary growth stimulation. The combination of the initial injury, imperfect reduction, and prolonged postoperative immobilization influences the functional outcome.

Conclusion: This work confirms that surgery alone, associating perfect reduction and rigid fixation, can enable early rehabilitation and improved results.