Management and outcome of a variant of posadas fracture in an adolescent patient: A case report

Fractures of the distal humerus in younger age group commonly involve the supracondylar extra articular area and do not have any associated dislocation. We present a rare variant of transcondylar fracture dislocation (posadas fracture) with articular extension and ipsilateral forearm fracture in an adolescent. A 16 year old male fell down while cycling and was brought to the trauma centre after 4 h. Anatomical reduction of articular fragments was achieved and stabilised with bicolumnar plating. Medial and lateral ulnar collateral ligaments were repaired and anterior capsule was reattached for stability after reduction of elbow. Forearm fractures were reduced and internally fixed with limited contact dynamic compression plating. ROM (range of motion) brace was applied with 30 degree extension block and active ROM exercises were advised for 4 weeks, followed by active assisted exercises for next 6 weeks under the supervision of a therapist. Patient was serially followed up for up to 1 year and after one year, the patient was pain free with ROM of 0 degree to 120 degree flexion and has resumed his previous activity levels. Displacement of transcondylar fragment due to pull of extensor and flexor muscles and articular involvement necessitates open reduction and adequate stabilization of both columns especially in older children and adolescents. Concurrent collateral ligament repair is essential in order to restore elbow stability and earlier commencement of ROM. Early restoration of joint anatomy can lead to good functional outcome.