The Outerbridge – Kashiwagi Technique for Fixation of a Transarticular Coronal Shear Fracture of the Distal Humerus

Abstract

Transarticular coronal shear fractures of the distal humerus pose a significant challenge to the surgeon in obtaining an anatomical reduction and rigid fixation. A variety of approaches have been described, including extended lateral and anterolateral approaches and arthroscopically-assisted fixation for noncomminuted fractures. Fixation methods include open or percutaneous cannulated screws and headless compression screws directed either anterior to posterior or posterior to anterior. We describe a novel approach to this fracture utilizing a fenestration of the olecranon fossa with a 4-cm triceps split (i.e. similar to the Outerbridge – Kashiwagi procedure) to insert a bone lever and achieve an anatomical reduction. The fracture was then fixed with headless compression screws directed from posterior to anterior. Early mobilization and rehabilitation were commenced and follow-up clinical examination and radiographs demonstrated full restoration of function with anatomical bony union. We consider that this technique comprises a feasible approach for fixing mild to moderately displaced transarticular coronal shear fractures with medial extension, where the fracture fragment is one block and there is no associated posterior comminution.