Surgical Management of Distal Humeral Fractures

Distal humeral fractures encompass a spectrum of injuries affecting the articular segment of the elbow, often presenting as complex intra-articular breaks that demand meticulous reconstruction. Surgical management aims to restore joint congruity, ensure stable fixation and facilitate early rehabilitation. Open reduction and internal fixation remains the gold standard in most active patients, utilising principles of anatomical reduction, rigid stabilisation and soft-tissue preservation. Approaches vary from olecranon osteotomy, which affords extensive exposure of both condyles, to triceps-sparing and anterolateral routes that minimise disruption of the extensor mechanism. Fixation devices include precontoured locking plates, antiglide or laterally applied plates supplemented by cannulated headless compression screws. Advances in three-dimensional imaging and classification systems, such as the Dubberley schema, inform preoperative planning by delineating fragment geometry. In elderly patients with severely comminuted fractures, elbow arthroplasty is emerging as a viable alternative, offering predictable pain relief and early motion at the expense of implant longevity. Despite technical refinements, complications such as nonunion, post-traumatic osteoarthritis and stiffness persist, highlighting the importance of balanced fixation, soft-tissue respect and structured rehabilitation protocols to optimise functional outcome.

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Surgical Management of Distal Humeral Fractures publication trend

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

Technical terms

Open reduction and internal fixation (ORIF): Surgical realignment of bone fragments followed by internal hardware application for stability.

Headless compression screw: A low-profile, threaded implant designed to compress fracture fragments without prominent hardware.

Antiglide plate: A plate applied to counteract shear forces across a fracture, commonly on the anterior aspect of the distal humerus.

Coronal shear fracture: A fracture in the coronal plane traversing the capitellum and/or trochlea of the distal humerus.

Dubberley classification: A system categorising capitellar and trochlear fractures by fragment number and posterior comminution to inform surgical strategy.

References

1. Optimal screw orientation for fixation of coronal shear fractures: a biomechanical comparison. Journal of Shoulder and Elbow Surgery (2024).
2. Elbow dislocation approach for complex elbow fractures: a cadaveric study. Journal of Orthopaedic Surgery and Research (2023).
3. Coronal Shear Fractures of the Distal Humerus. Journal of Functional Morphology and Kinesiology (2022).