Abstract

SEQUENTIAL SURGICAL STRATEGY FOR BILATERAL OPEN HUMERAL PALLET FRACTURES IN A PATIENT WITH A PSYCHIATRIC DISORDER: A CASE REPORT

Moustapha Etapea,* Paul Koulemoua, Hamza Kettania, Mamfoumbi Mbadinga Noel Juslina, Kamal El Moktaria, Azzelarab Bennisa, Omar Zaddouga, Mohammed Benchakrouna, and Salim Bouabid

ABSTRACT

Humeral pallet fractures are fractures located between the distal insertion of the anterior brachialis muscle and the elbow joint. These are rare lesions which generally occur in the context of high energy trauma (falls from heights and road accidents) and mainly concern young male adults. Also, they are most often unilateral and account for 1 to 2% of adult fractures. Bilateral HPF are rarer and seldom reported. The anatomical complexity of the distal extremity of the humerus, the frequent multifragmentary nature of these fractures, as well as the proximity of the radial and ulnar nerves are all reasons why these fractures constitute a real therapeutic challenge for the trauma surgeon. More so, one must bear in mind that the elbow is prone to stiffness, thus early rehabilitation is of paramount importance, whatever the chosen treatment strategy. In order to begin early functional rehabilitation so as to avoid elbow stiffness, open reduction and internal fixation with the use of the most stable available osteosynthesis implants is currently considered the standard of care for these fractures. In this case report, we describe the treatment strategy adopted for a rare case of bilateral humeral pallet fracture that occurred in a context of attempted suicide in a 23-year-old female patient with a history of psychiatric disorder. It actually occurred following a fall from the first floor of a building. A two-stage open reduction and internal fixation method was chosen for definitive treatment. Lecrestre’s and third-tube plates were used for the fixation of each elbow coupled with a tension band for the left olecranon.

Keywords: Bilateral humeral pallet fracture; elbow stiffness; distal humerus; intraarticular fracture; open reduction and internal fixation.