This paper attempts to design a clinically applicable classification system for distal humeral fractures that would provide guidance to the surgeon with regard to surgical approach and operative management. The classification system was originally introduced from a study comparing distal humeral fracture classifications undertaken in Oxford, England. Nine independent investigators were asked to classify 33 sets of radiographs using the Classification System of Riseborough and Radin, Mehne and Jupiter, the AO Classification as well as a new system. Inter- and intra-observer agreement was determined. The authors concluded that their classification system was both substantially reliable and reproducible when compared to other systems.
This classification system takes into account the approach, surgical treatment of, and outcomes following these injuries. Type I fractures are extra-articular and would be analogous to extra-articular fractures in other classification systems. In their Type II injuries, they describe single column injuries or simple articular fractures in which the fracture lines begin within the distal humeral metaphysis and then propagate into the trochlea, capitellum or both. Type III fractures are those which have been previously termed “articular fractures.” These represent shear-type fractures in either the anteroposterior or lateral plane, and therefore represent the AO subgroups of B3, C1 and C3.
The significance of this article is that it points out the difficulty in the management of articular shear fractures involving the distal humerus. These shear injuries, whether they are in the lateral plane or in the frontal plane, represent the most difficult to approach, visualize and stabilize. In addition, they are associated with a higher number of complications and a higher number of revision surgeries than either of the other two subgroups.
Humerus, Fracture, Classification, Elbow
J Shoulder and Elbow Surg