Clinical Details

Clinical and radiological findings:  This cases of a 70-year old alcoholic following an intoxicated full who sustained the above comminuted distal humerus fracture. A closed injury the arm was neurovascularly intact. Plain film imaging is not provided as as only CT imaging can truly demonstrate the extent of injury. Here is a sagittal split of the ulnar column evident with a sagittal split separating trochlea from capitellum. There are multiple small comminuted fragments inbetween these main fragments. Also dorsally in the transition to the olecranon fossa several trochlea fragments are evident. The history suggested that this was a fresh fracture. However the reliability of the patient came into question intraoperatively as as a blunted rounding of the fragments along with callous interposition would suggest a fracture several weeks old. The pre-operative plan did not predict the need for an osteotomy however after initial intra-operative assessment this plan was modified