Injury Vol. 26, No. 3, pp. 169-173, 1995 Copyright (Q 1995 Else&r Science Ltd Printed in Great Britain. All rights reserved OOZO-13831951 $10.00 + 0.00 Operative treatment of type C intra-articular fractures of the distal humerus: the role of stability achieved at surgery on final outcome N. Papaioannou, G. Ch. Babis, J. Kalavritinos and Th. Pantazopoulos Orthopaedic Department of the University of Athens, ‘KAT’ Accident Hospital, Athens, Greece We report the results of 75 patients with type C infru-arficularfrucfttre of the disfal humerus treated operatively by two methods and followed up for a mean period of 48.2 months. Minimal osfeosynthesis and joint immobilization was used in 21 cases while the remaining 54 pafienfs were treated according to A0 recommendations. Good or excellent results were found in 38 per cent after minimal osfeosynfhesis and in 77.8 per cent following fhe A0 technique. 87.8 per cenf of the cases with stable osfeosynthesis and early mobilization had a good or excellent resulf as compared with 41.2 per cent of the cases affer unstable fixation and immobilization of the joinf (P < 0.07). The type of fracture was found to be an important factor in achieving sfable fixafion lp < 0.01). Injury Vol. 26,No. 3, 169-173, 1995 Introduction Intra-articular fractures of the distal humerus are serious injuries of the elbow, and their exact mode of treatment has been controversial until recently. Until the early 1970s most surgeons believed that the treatment of choice should be non-operative’-4. After a brief transitional period of variable resultsfollowing several ways of surgical manage- ment5r6, the new techniques and instrumentation intro- duced by the AO’ helped to establishoperative treatment of these fractures. With this method of treatment, accurate reduction and stable internal fixation is often achieved, allowing early mobilization of the joint and usually satisfactory functional results. There are, however, only a limited number of publications written by surgeons from Europe following the A0 techniques-14. There are casesof severely comminuted fractures in which anatomic reduction and stable fixation is difficult to accomplish and in which immobilization is often needed. Immobilization is often necessary in the case of minimal osteosynthesis resulting in unstable fixation. The present series consistsof a number of thesedifficult fractures treated either by the A0 method or minimal osteosynthesis followed by immobilization. Immobil- ization was also applied in a number of cases treated by the A0 method in which stable fixation was not accomplished. The aim of our study was to evaluate the consequences of the method of treatment, the outcome of immobilization of the joint after an unstable fixation and to comment on the type and the severity of the fracture in accomplishing a stable fixation. Materials and methods Eight-seven patients with type C intra-articular fracture of the distal humerus were treated operatively from January 1979 to January 1992. Complete data were available in 75 patients. Thirty of them were males. The mean age was 50.6 years (range 17-83). Men were significantly younger than women (mean age 39.5 and 61.5 years respectively). The fractures were classified according to the A0 system’5 (Table I). N’ me of the fractures were open. The most frequent accompanying injury was injury of the ipsilateral shoulder, which occurred in 17 patients includ- ing five fractures of the humeral head and three shoulder dislocations. Twenty-one of our patients underwent their operation on the day of injury, 32 during the first week and the remaining patients were delayed for various reasons. In the early 198Os, minimal osteosynthesis was per- formed using single screwsand Steinmann pins after either osteotomy of the olecranon or split of the triceps insertion and reduction of the fracture. There were 21 (28 per cent) such cases. Plaster immobilization was applied for 6-8 weeks followed by prolonged physiotherapy (FigureI). The technique was subsequently modified to follow the A0 guidelines. There were 54 cases (72 per cent) treated by the A0 method. After reduction of the main intra- articular fragments and temporary osteosynthesis with K-wires, a transcondylar screw was applied. Osteosynthe- sis was completed using one or two l/J-tubular or dynamic compression plates for fixation of the condyles to the humeral diaphysis (Figure 2). Stable fixation was achieved in 41 of these 54 cases in which early active physiotherapy was instituted within the Table I. A0 classification of fractures Cl 16 (21.3%) c2 34(45.3%) c3 25(33.40/o)