Treatment of High-Energy Supracondylar/Intercondylar Fractures of the Distal Humerus

Operative treatment of high-energy intra-articular fractures of the distal humerus is challenging and controversial. We conducted a retrospective study at a Level I trauma center to evaluate the results of a specific treatment protocol. Seventy-one patients were treated through a posterior olecranon osteotomy. Capsulectomy was performed in patients who perceived their functional range of motion to be limited after an average of 10 months. Clinical followup consisted of physical examination, radiography, and completion of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Average followup duration was 22 (range, 6 to 70) months. Sixty-five percent of the patients achieved excellent or good results, 28% fair, and 7% poor. Thirty-one percent underwent capsulectomy, with 59% of those patients achieving excellent or good results. This is the largest series reported to date. Our patients experienced mild functional impairment and a low rate of nonunion. We advocate capsulectomy for patients with limited range of motion postoperatively. (Journal of Surgical Orthopaedic Advances 20(4):230–235, 2011)