Intra-articular distal humerus fractures require anatomic reduction with stable fixation to facilitate early range of motion. These fractures may have an associated coronal shear capitellar fragment. Internal fixation of capitellar shear fragments is a challenge because of difficulty attaining anatomic reduction and stable angular fixation via current exposure and fixation approaches.

An olecranon osteotomy is the most popular method for the exposure of intra-articular distal humerus fractures; however, it is limited by inadequate visualization of the anterior articular surface. We describe a surgical technique with release of the lateral ulnar collateral ligament to afford complete exposure of the anterior joint surface. Parallel plating of the columns does not allow for the perpendicular placement of screws into coronal fragments. Our approach involves the use of an additional posterolateral plate to more adequately capture coronal capitellar fragments. This fixation method allows for visualized anatomic reduction and fixation, with an angular, stable plate-screw construct used to manage the coronal fragments.