M.E.Müller: Atlas: Fracture 13-C3

Humerus, Distal,
complete articular fracture,
articular multifragmentary 0,31% of the total
4,34% of the femur
10,76% of the segment

87 fractures 51,2% group 37%M, 63%F

63 fractures
37,0% group
37%M, 63%F

20 fractures 11,8% group
56%M, 44%F

Metaphyseal simple Metaphyseal wedge +Q Metaphyseal complex

These are multifragmentary, complete articular fractures of the distal humerus. The subgroup depends on the metaphyseal fracture line: simple (C3.1), wedge (C3.2) or complex (C3.3). Ref. Manual of Internal Fixation:
204 - 208. 446 - 451.
Surgeon. RG, RO.

The main difficulty of this group is the reduction of the multifragmented articular fracture, frequently with free osteochondral fragments (tissue loss). If the fragments are of sufficient size, they should be reduced and fixed with mini fragment screws as in the first illustrated case. If the fragments are not viable, it is better to substitute them by cancellous bone graft. Once the articular surface is reconstructed, it is fixed to the diaphysis with contoured reconstruction plates placed in the posterior aspect or in the columnar lateral borders.

When the metaphyseal fracture has a large third fragment

or it is of the complex type, we prefer to first reduce and fix the third fragment to the proximal one in order to simplify the fracture (four lag screws in the illustrated case). The articular fracture is then reduced and fixed with an interfragmentary compression transcondylar screw, either isolated or through the plate. It is then necessary to reduce and fix the supracondylar fracture with plates fixed with unicortical small screws. We want to remark that in the metaphyseal cortex, because of its hardness, unicortical screws will give enough hold if no interfragmentary compression is to be performed (neutralization plate).

preoperative + 1 year

preoperative + 1 year

preoperative + 6 months

preoperative + 6 months




						Humerus, Distal, complete articular fracture, articular multifragmentary	0,31% of the total 4,34% of the femur 10,76% of the segment






These are multifragmentary, complete articular fractures of the distal humerus. The subgroup depends on the metaphyseal fracture line: simple (C3.1), wedge (C3.2) or complex (C3.3).		Ref. Manual of Internal Fixation: 204 - 208. 446 - 451. Surgeon. RG, RO.

The main difficulty of this group is the reduction of the multifragmented articular fracture, frequently with free osteochondral fragments (tissue loss). If the fragments are of sufficient size, they should be reduced and fixed with mini fragment screws as in the first illustrated case. If the fragments are not viable, it is better to substitute them by cancellous bone graft. Once the articular surface is reconstructed, it is fixed to the diaphysis with contoured reconstruction plates placed in the posterior aspect or in the columnar lateral borders. When the metaphyseal fracture has a large third fragment	or it is of the complex type, we prefer to first reduce and fix the third fragment to the proximal one in order to simplify the fracture (four lag screws in the illustrated case). The articular fracture is then reduced and fixed with an interfragmentary compression transcondylar screw, either isolated or through the plate. It is then necessary to reduce and fix the supracondylar fracture with plates fixed with unicortical small screws. We want to remark that in the metaphyseal cortex, because of its hardness, unicortical screws will give enough hold if no interfragmentary compression is to be performed (neutralization plate).