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A three-year-old girl suffered a T-condylar fracture of the distal humerus. Open reduction and pinning were performed. Three years after injury, there was no functional disturbance or radiographic evidence of avascular necrosis or epiphyseal growth arrest.

Background: Distal Humerus Articular Fracture (classified by Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association as 13-B3) is an uncommon fracture with significant complications. We report results of 14 patients treated by open reduction and pin-and-plate fixation technique.

Methods: In this retrospective study, we applied pin-and-plate fixation to 14 distal humerus articular fractures, in which screw fixation alone was inefficient or inadequate to provide stable fixation. After anatomical reduction of articular fragments, multiple Kirschner wires were inserted through the fragments. To prevent migration of Kirschner wires a small plate was placed proximally on the bent end of the pins.

Results: The average age of 14 patients (8 males and 6 females) was 36.4 years (range: 16–57) and the mean follow up period was 43 months (range: 12–80). At last follow up the average quick Disabilities of the Arm, Shoulder and Hand score was 18.9 (range: 2.3–42.5) and the mean points for Mayo Elbow Performance Index was 75.3 (range: 50–100). Mean final arc of flexion-extension was 97° (range: 40–131).

Conclusions: Distal humerus articular fracture is sometimes difficult to fix with conventional methods. We used pin-and-plate technique that could make a stable fixation and allow early range of motion with acceptable results.

Background: The senior author adopted a Triceps Split and Snip approach in 2011. This paper details the results of patients for whom this approach was utilised for open reduction and internal fixation of complex AO type C distal humerus fractures.

Methods: A retrospective analysis of a single surgeon’s cases was conducted. Range of movement, as well as Mayo Elbow Performance Score (MEPS), and QuickDASH scores were evaluated. Two independent consultants with upper extremity practises evaluated pre- and post-operative radiographs.

Results: Seven patients were available for clinical review. The mean age at the time of surgery was 47.7 years (range, 20.3–83.2) and the mean follow-up time was 3.6 years (range, 0.58–8). The average QuickDASH score was 15.85 (range, 0–52.3), average MEPS was 86.88 (range, 60–100) and average total arc of movement (TAM) was 103° (range, 70°–145°). All patients demonstrated 5/5 MRC triceps strength compared to the contralateral side.

Conclusions: The Triceps Split and Snip approach for complex distal humerus fractures provided comparable mid-term clinical outcomes when compared to other published data regarding distal humerus fractures. It is versatile and does not compromise the intra-operative option of conversion to a total elbow arthroplasty.

Level of Evidence: Level IV (Therapeutic)