Fractures sus et inter-condyliennes de l’humérus distal chez l’adulte

INTRODUCTION: complete joint fractures of the lower end of the humerus are rare and severe injuries in adults, affecting the functional prognosis of a narrow and complex joint such as the elbow. Multiple therapeutic options are available, but osteosynthesis is widely used provided that it can recover stable, mobile, and painless joint. The purpose of our study was to describe the epidemiological, clinical, radiological and therapeutic features of these fractures, as well as to evaluate functional outcomes in our patients. METHODS: we conducted a 3-year prospective study (January 2014-December 2016) of 38 patients older than 16 years admitted with complete sub- and intercondylar joint fracture of the lower extremity of the humerus (classified as type C according to the AO classification). They underwent surgery via transolecranian posterior approach with fixation of one or two screw plates based on anatomopathological diagnosis. Patients were followed-up for a mean period of 34 months. RESULTS: these conditions had bimodal distribution, affecting young male subjects on the one hand and elderly female subjects on the other. The main cause of fractures was road accidents (78%). During the follow-up period, one case had superficial surgical site infection and there were no cases of dismantling of equipment or pseudarthrosis. No complications after osteosynthesis for olecranon fractures were recorded in our case series. Stiffness at the elbow-joint was defined as bending/extension arc less than 50°; elbow stiffness was found in 25% of patients. Functional results were assessed using the Mayo-Clinic or Mayo-Clinic Elbow Performance Score (MEPS) with an average score of 86. CONCLUSION: based on our results, transolecranon posterior approach is the best option for these fractures, since it allows good joint exposure. This is essential for perfect anatomical restitution and stable osteosynthesis in order to undertake early and adapted rehabilitation.