Condylar fractures are intra-articular injuries involving the distal humerus (capitellum, trochlea, lateral or medial column) or distal femur (medial or lateral condyle, intercondylar). They are challenging injuries due to articular involvement, complex anatomy, soft tissue concerns, and high complication rates including stiffness, post-traumatic arthritis, non-union, and heterotopic ossification.
Distal humerus fractures classification (AO/OTA 13-A, B, C) ranges from extra-articular supracondylar (13A) to partial articular (13B: lateral/medial condyle, capitellum-trochlea) and complete articular bicondylar (13C). Mechanisms include falls (elderly, osteoporotic) and high-energy trauma (young adults). Distal femur fractures (AO/OTA 33-A, B, C) similarly classified, with bicondylar intercondylar fractures (33C) being most complex. Risk of post-traumatic arthritis approaches 100% with imperfect articular reduction.
Surgical management requires anatomic reduction and rigid fixation. Distal humerus approaches include olecranon osteotomy (for complete articular access), triceps-splitting, paratricipital, or anterior approaches. Fixation typically employs dual orthogonal locking plates (one medial column, one posterolateral column) for column stability. Distal femur fractures use lateral locking plate, intramedullary nail, or combination, with attention to coronal plane alignment and rotational control. Total elbow arthroplasty is option for elderly patients with complex distal humerus fractures, particularly with osteoporotic bone or pre-existing arthritis. Postoperative early range of motion is critical to prevent stiffness.