title: Outcomes following distal humeral fracture fixation with an extensor mechanism-on approach.
abstract: BACKGROUND
  Distal humeral fractures have traditionally been managed with surgical approaches that disrupt the extensor mechanism. We hypothesized that an extensor mechanism-on approach for operative fixation of distal humeral fractures with parallel or orthogonal plate constructs would allow excellent healing, a motion arc of the elbow exceeding 100°, and maintenance of extensor mechanism strength.
  
  
  METHODS
  Distal humeral open reduction and internal fixation (ORIF) was performed with either orthogonal or parallel plate constructs in seventy-nine elbows. Thirty-seven elbows were fixed via an extensor mechanism-on surgical approach, and twenty-four of them were available for additional evaluation. Radiographs as well as MEPI (Mayo Elbow Performance Index), DASH (Disabilities of the Arm, Shoulder and Hand), and SF-36 (Short Form-36) scores were obtained.
  
  
  RESULTS
  All thirty-seven fractures healed primarily. Three elbows underwent later release because of stiffness. The median arc of elbow motion was 126° (range, 60° to 141°). The mean MEPI was 91.5 points and the mean DASH score was 15.9 points, indicating excellent scores with mild impairment. The median percent loss of triceps strength was 10% (range, 0% to 49%) compared with the contralateral, normal elbow.
  
  
  CONCLUSIONS
  Open treatment of distal humeral fractures with an extensor mechanism-on approach results in excellent healing, a mean elbow flexion-extension arc exceeding 100°, and maintenance of 90% of elbow extension strength compared with that of the contralateral, normal elbow.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, 981080 Nebraska Medical Center, Omaha, NE 68198, USA. jerpelding@medicine.nodak.edu
authors.forename: Jason M
authors.initials: JM
authors.lastname: Erpelding
authors.forename: Adam
authors.initials: A
authors.lastname: Mailander
authors.forename: Robin
authors.initials: R
authors.lastname: High
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Mormino
authors.forename: Edward V
authors.initials: EV
authors.lastname: Fehringer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D006811:Humerus / Q000293:injuries* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D055815:Young Adult