Intra-Articular Osteotomy for Distal Humerus Malunion
(a) Our patient was a 48-year-old dentist who was seen 10 months after a high energy fall that resulted in a complex intra-articular fracture of her left nondominant distal humerus. (b) Initial treatment performed at an outside institution consisted of static external fixation with the arm in flexion and the forearm in neutral rotation. (c) The external fixator was removed after 8 weeks and follow-up the radiographs revealed distal humerus intra-articular malunion. (d) An oscillating saw was used to create a trapezoid wedge to correct overlength varus of the lateral column and flexion of the capitellum in order to realign capitellum and trochlea. Extreme caution was taken no to disrupt blood supply of the capitellum. (e) The patient had loss of anterior translation of the distal end of the humerus resulting in loss of flexion of 35 degrees, with 10 degrees of hyperextension of the left elbow. (f) Patient opted for removal of hardware and extra-articular excavation of the prominent ventral distal humerus creating a new fossa coronoidea in order to gain flexion.
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