title: Distal-third diaphyseal fractures of the humerus: choice of approach and surgical treatment.
abstract: OBJECTIVE
  Distal-third diaphyseal fractures of the humerus are often hard to treat due to location and pattern of the fractures, radial nerve injury, and quality of bone and age of patients. The aim of this retrospective study is to propose the best approach and the best surgical technique according to the pattern of extra-articular fracture of the distal humerus.
  
  
  METHODS
  We have treated 37 fractures of the distal humerus between January 2010 and July 2015 classified according to the AO classification. There were 2 open fractures. We treated all fractures with open reduction and internal fixation with plates and screws. In 20 cases, we performed a posterior midline triceps-splitting approach, with patients in prone decubitus position; in 2 cases, the triceps-splitting approach with the patients in supine decubitus position; in 3 cases, the olecranon osteotomy approach in prone decubitus position; and in 12 cases, the lateral approach in supine decubitus position.
  
  
  RESULTS
  Thirty cases had a medium follow-up of 6 months. We observe 2 post-operative radial nerve palsies healed in 5 months and 2 cases of non-union. The average time to union of remaining cases was 16 weeks (range 12-24). Elbow motility was complete in 25 cases, in 4 cases there was an extension loss of 5°, and in one case there was an extension loss of 10°.
  
  
  CONCLUSIONS
  The use of plates allows an anatomical fracture reduction, a better control of alignment of humerus and, with a rigid fixation, an early elbow mobilization. The best approach and the best surgical technique depend on the pattern of the fracture of distal humerus.
authors: Orthopedic and Traumatology Department, Ospedali Riuniti, Ancona, Italy. alexandre_m@libero.it.
authors: A
authors: A
authors: Maresca
authors: Orthopedic and Traumatology Department, Ospedali Riuniti, Ancona, Italy.
authors: R
authors: R
authors: Fantasia
authors: Orthopedic and Traumatology Department, Ospedali Riuniti, Ancona, Italy.
authors: M
authors: M
authors: Cianforlini
authors: Orthopedic and Traumatology Department, Ospedali Riuniti, Ancona, Italy.
authors: N
authors: N
authors: Giampaolini
authors: Orthopedic and Traumatology Department, Ospedali Riuniti, Ancona, Italy.
authors: S
authors: S
authors: Cerbasi
authors: Orthopedic and Traumatology Department, Ospedali Riuniti, Ancona, Italy.
authors: R
authors: R
authors: Pascarella
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011826:Radial Nerve / Q000293:injuries*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Distal-third diaphyseal fractures of the humerus; Extra-articular distal humeral fracture; Midline triceps-splitting approach; Radial nerve injury