M.E.Müller: Atlas: Fracture 13-A3

Humerus, Distal,
extra-articular fracture,
metaphyseal multifragmentary 0,09% of the total
1,33% of the femur
3,60% of the segment

21 fractures 40,4% group 37%M, 63%F

12 fractures
23,1% group
70%M, 30%F

19 fractures 36,5% group
44%M, 56%F

With an intact wedge +Q With a fragmented wedge +Q Complex

These are multifragmentary extra-articular fractures of the distal humerus, metaphyseal, with a fragmented wedge. Ref. Manual of Internal Fixation:
204 - 208. 446 - 451.
Surgeon. RG.

The illustrated case is a special one because it is a third degree open fracture with associated fractures of the radius and the ulna. This case is shown as an example of the possibility of combining the internal and external fixation methods in largely open fractures with bone and soft tissue loss, where the internal fixation should be minimal.

The wedge fragment is fixed to the proximal fragment by a lag screw. A reconstruction plate, contoured to the medial border of the distal humerus and fixed with only

four screws, stabilizes the supracondylar fracture. An external fixator, placed on the radial side, provisionally complements the stability. The possible associated neurovascular lesions are then repaired. The skin and muscle tissue loss are replaced by a latissimus dorsi pediculated muscle graft covered with a meshed skin graft. Once the healing is obtained, the external fixator is removed.

Another example of a vascularized muscle graft is shown in the 42-C3.3 fractures.

preoperative preoperative

postoperative postoperative

+ 6 months + 6 months




						Humerus, Distal, extra-articular fracture, metaphyseal multifragmentary	0,09% of the total 1,33% of the femur 3,60% of the segment






These are multifragmentary extra-articular fractures of the distal humerus, metaphyseal, with a fragmented wedge.		Ref. Manual of Internal Fixation: 204 - 208. 446 - 451. Surgeon. RG.

The illustrated case is a special one because it is a third degree open fracture with associated fractures of the radius and the ulna. This case is shown as an example of the possibility of combining the internal and external fixation methods in largely open fractures with bone and soft tissue loss, where the internal fixation should be minimal. The wedge fragment is fixed to the proximal fragment by a lag screw. A reconstruction plate, contoured to the medial border of the distal humerus and fixed with only	four screws, stabilizes the supracondylar fracture. An external fixator, placed on the radial side, provisionally complements the stability. The possible associated neurovascular lesions are then repaired. The skin and muscle tissue loss are replaced by a latissimus dorsi pediculated muscle graft covered with a meshed skin graft. Once the healing is obtained, the external fixator is removed. Another example of a vascularized muscle graft is shown in the 42-C3.3 fractures.