title: Intra-articular osteotomy for malunited articular fractures of the distal end of the humerus.
abstract: BACKGROUND
  The precarious anatomy of the articular surface of the distal humerus, as well as its meager subchondral bony support and limited soft-tissue attachments, presents enormous challenges for the operative correction of post-traumatic intra-articular deformities. This study presents 8 patients who underwent articular osteotomy with a mean follow-up period of 10.6 years, with an emphasis on functional, patient-rated, and radiographic outcomes.
  
  
  METHODS
  Eight patients (mean age, 39 years; range, 17-60 years) were followed up for a mean period of 10.6 years. The original fracture was a type C variant in 4 patients, a type B unicondylar fracture in 2, and a type B articular shearing fracture in 2. The initial injury was treated operatively in 5 patients and nonoperatively in 3. The osteotomy and reconstruction were performed on average 8 months after injury (range, 6-11 months). The mean preoperative elbow arc of motion was 37°. Two patients had ulnar nerve dysfunction.
  
  
  RESULTS
  All the osteotomies healed after the index procedure without evidence of avascular necrosis. Two patients required a second procedure for stiffness. At follow-up, the mean arc of elbow motion improved to 104° (P = .001), with a mean flexion contracture of 26°. The mean Disabilities of the Arm, Shoulder and Hand score at follow-up was 13 (range, 1-37); the mean patient satisfaction rating on a Likert scale (from 0 to 10) was 9.1; and the mean Mayo Elbow Performance Index score was 83 points (range, 70-100 points). Grade II osteoarthritic changes were seen in 3 patients, grade I in 3, and grade 0 in 2.
  
  
  CONCLUSIONS
  In selected patients with a defined intra-articular malunion, the results of our experience support corrective osteotomy.
authors.affiliation: Division of Hand and Elbow Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. Electronic address: mark_s_cohen@rush.edu.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Cohen
authors.affiliation: Harvard Medical School and Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Jupiter
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult; D000092464:Elbow Injuries
keywords: Distal humeral fracture; elbow; fracture fixation; intra-articular fracture; malunion; outcomes; shear fracture