Management of Distal Humerus Fractures

Distal humerus fractures represent a small but complex subset of adult elbow injuries, often involving intra-articular comminution that challenges restoration of anatomy and joint function. Modern management prioritises open reduction and internal fixation (ORIF) with contoured, locking plates arranged in parallel or orthogonal configurations to optimise biomechanical stability. Surgical exposure may employ olecranon osteotomy or triceps-reflecting approaches to achieve adequate articular visualisation while preserving extensor function. In cases of severe comminution or osteoporotic bone where reconstruction is not feasible, hemiarthroplasty or total elbow arthroplasty offers an alternative, trading off implant longevity against early mobility. Postoperative rehabilitation focuses on early controlled motion to minimise stiffness and maximise functional recovery. Outcomes are influenced by patient factors such as bone quality and comorbidities, surgical technique including nerve handling, and implant selection, with ongoing research refining fixation strategies and minimising complications such as nonunion and ulnar neuropathy.

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Management of Distal Humerus Fractures publication trend

The graph below shows the total number of articles in management of distal humerus fractures across all publications each year (not limited to Nature Index journals).

Technical terms

Comminuted fracture: A fracture in which the bone is broken into three or more fragments.

Open reduction and internal fixation (ORIF): Surgical realignment of a fracture followed by stabilisation using plates, screws or wires.

Total elbow arthroplasty (TEA): Replacement of the distal humerus and proximal ulna with a linked prosthetic implant.

Hemiarthroplasty: Replacement of one articular surface, typically the distal humerus, while preserving the native ulna.

Nonunion: Failure of a fractured bone to heal within the expected timeframe, often requiring further intervention.

Orthogonal plating: Placement of two fixation plates at right angles to each other to enhance construct stability.

Olecranon osteotomy: Surgical division of the olecranon process to improve visual and instrumental access to the distal humerus.

Ulnar nerve transposition: Surgical relocation of the ulnar nerve, typically anterior to the medial epicondyle, to relieve tension and reduce neuropathy risk.

References

1. Biomechanical comparison of anatomical plating systems for comminuted distal humeral fractures. International Orthopaedics (2017).
2. Distal Humeral Fractures-Current Concepts. The Open Orthopaedics Journal (2017).
3. The triceps reflecting approach (Bryan-Morrey) for distal humerus fracture osteosynthesis. BMC Musculoskeletal Disorders (2014).
4. Comparison of the Complications, Reoperations, and Clinical Outcomes between Open Reduction and Internal Fixation and Total Elbow Arthroplasty for Distal Humeral Fractures in the Elderly: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine (2022).
5. Risk Factors for Non-Union after Open Reduction and Internal Fixation in Patients with Distal Humerus Fractures. Journal of Clinical Medicine (2022).
6. Three-dimensional mapping of distal humerus fracture. Journal of Orthopaedic Surgery and Research (2021).
7. The role of ulnar nerve subcutaneous anterior transposition during open reduction and internal fixation of distal humerus fractures: a retrospective cohort study. International Orthopaedics (2020).