­¦ý°±·>œ +-œ,Ï€¡M •øYbjbj’=’= 2ÄWÄWY lÊÊÊÊÊÊÊ™^^^^ j ™ ÇÇÇÇÇ]]]ç è è è è è è $Ÿ ”³„ Ê]]]]]„ ÊÊÇǤ» ]ÇÊÇÊÇç ]ç by ÊÊy Çv @ÈÈ(Ë»™d^þy y Þ 0 y ž"y ™™ÊÊÊÊFractures of the Medial Column of the Distal Humerus in Adults Kim M Brouwer MSc *ß, Thierry G Guitton BS*, Job N Doornberg PhD*ß, Peter Kloen MD PhD*, David Ring MD PhDß *Academic Medical Center Amsterdam, The Netherlands ßMassachusetts General Hospital, Boston, United States of America Background: Fractures involving the medial column of the distal humerus alone (i.e. the lateral column remains intact) are uncommon in adults. 24 adults patients were found in the English language literature; only two were noted to have articular fragmentation. Under the impression that these fractures often involve complex articular fragmentation, we reviewed the experience of two level-one trauma centres. Methods: All patients undergoing operative fracture treatment at one of our institutions have been entered in a prospective database since 1974. 3% of all distal humerus fractures was a 13 B2 fracture. Four patients returned for an evaluation, the remaining ten patients from the other institution were evaluated from the medical record. There were 10 men and 4 women with an average age of 63 years. The mechanism of injury was a fall form standing height in most patients. There was one B2.1 fracture (through the trochlea), 3 B2.2 fractures (including the trochlea in the fracture fragment), 9 B2.3 (multi-fragmentary) and one C3.2 fracture (mainly involving the medial column with lateral articular involvement). 13 patients were treated with operatively; one was initially stabilized with an external fixator. Six fractures were approached through an olecranon osteotomy. Three patients had immediate postoperative ulnar nerve dysfunction; there were three post-operative infections. Two patients had a subsequent surgery to address stiffness, one to address non-union. Four patients underwent hardware removal. Results: At final follow-up at an average of 6 years (2 months to 22 years), the arc of ulna humeral motion averaged 87 degrees, the average flexion was 115 degrees and the average flexion contracture was 29 degrees. Average forearm rotation was 166 degrees and all elbows were stable. According to the Broberg and Morrey Funtional Rating Index the result was excellent in three patients, good in nine, fain in one and poor in one, with an average good result. Six patients had arthrosis according to the radiographic criteria of Broberg and Morrey. Conclusions: Only 26 adult patients with a fracture of the medial column were found in the literature, of which 18 had a good or excellent result. Operatively treated patients had a better result than conservatively treated patients. We only found two B2.3 fractures (multi-fragmentary); both had a good result. Two fracture classifications for single column fractures for the distal humerus are used, but do not note the occurrence of complex articular fragmentation. Surgeons should be aware of the potential complexity of this fracture pattern, even though most patients had a good to excellent outcome. Computed tomography can help define the fracture anatomy and facilitate planning surgery. Open reduction and internal fixation is the best treatment option, also in the long term. ?QSijÅïñ©´¨þý"-ø» & E R Y™ÛÎÛÎÛÎÛÎÛÎÛ”ÞÎÛ÷‹÷‹÷‹÷‹mH sH 6Å]ÅmH sH  5ÅCJ\Å 5ÅCJH*\ÅCJH*mH sH  CJmH sH  5ÅCJ \Å?´þ!"/æø»  & D E R Y—Ú—Ú••••••••••••$a$$d•a$Yœ0&P1êhƒ³/ ƒ’=!ƒV"ƒ°#êÍ$êÝ%ƒƒ‰ƒ‰ êŸ i8@Ò8 NormalCJ_HaJmHsHtH >@> Heading 1$dh@& 5ÅmH sH <A@Ú°< Default Paragraph FontY  ?´þ!"/æø»&D E R [ 0ÄÄò0ÄÄ@0ÄÄò@0ÄÄò0ÄÄò0ÄÄò@0ÄÄò@0ÄÄò@0ÄÄò0ÄÄò@0ÄÄò@0ÄÄò0ÄÄò@0ÄÄò@0ÄÄö0ÄÄY Y Y •8•@ÒÄÄÄ—•í••0•( • ••B •S •øÀ ?•_fâ釈PRÂÏLSX^_h/ 6 ; A [ Pâ[ PàE Q [  Kim BrouwerâC:\Documents and Settings\kim\My Documents\Medial Collumn Fractures DH\Fractures of the Medial Column of the Distal Humerus in Adults.doc Kim BrouwerSC:\Documents and Settings\kim\My Documents\Medial Collumn Fractures DH\Abstract.doc Kim Brouwer_C:\Documents and Settings\kim\Application Data\Microsoft\Word\AutoRecovery save of Abstract.asd Kim BrouwerSC:\Documents and Settings\kim\My Documents\Medial Collumn Fractures DH\Abstract.doc Kim BrouwerSC:\Documents and Settings\kim\My Documents\Medial Collumn Fractures DH\Abstract.doc Kim BrouwerSC:\Documents and Settings\kim\My Documents\Medial Collumn Fractures DH\Abstract.doc Kim BrouwerSC:\Documents and Settings\kim\My Documents\Medial Collumn Fractures DH\Abstract.doc Kim Brouwer_C:\Documents and Settings\kim\Application Data\Microsoft\Word\AutoRecovery save of Abstract.asd Kim BrouwerSC:\Documents and Settings\kim\My Documents\Medial Collumn Fractures DH\Abstract.doc Kim BrouwersC:\Documents and Settings\kim\Desktop\KM Brouwer Fractures of the Medial Column of the Distal Humerus in Adults.doc"[ _·¢@ÄQQx…BQPY ¿@UnknownGêáz ÄTimes New Roman5êÄSymbol3&ê áz ÄArial"qà•­hÇš†fÇš†fŠ. 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