Distal humerus fractures: a review of current therapy concepts

Abstract

Fractures of the distal humerus in the adult comprise approximately one third of all humeral fractures. Successful management of distal humerus fractures depends on correct reduction of the fracture, reconstruction of the articular surface if needed, stability and rigidity of the fixation, and appropriate rehabilitation. In this review, we evaluated the available literature and highlighted current therapy concepts. We assessed the evolution of internal fixation and elbow arthroplasty focusing on the established surgical approaches against the background of a growing incidence of distal humeral fractures in an aging patient population. Therefore evaluating the aspect and influence of age-dependent comorbidities like osteoporosis on successful treatment.

Current Fixation Options for Elbow, Forearm, Wrist, and Hand Fractures

“…Fractures of the distal humerus are challenging complex injuries that frequently require surgical intervention to achieve an acceptable functional outcome. [16][17][18] The incidence in adults follows a bimodal distribution with most cases occurring either in men age 18 to 40 years (typically due to high-energy trauma) or in women > 65 years (typically due to low-energy trauma where underlying osteoporosis is often a predisposing factor). [18][19][20][21] Distal humerus fractures are most common overall in young children, but the management of pediatric fractures is beyond the scope of this article.…”

“…Open reduction and internal fixation (ORIF) is the preferred surgical intervention and standard of care for these fractures with the approach and hardware placement dependent on the fracture type. 17,21 However, primary total elbow arthroplasty is an alternative option that has been used increasingly for trauma in elderly patients in the past decade. 22 Fractures of the distal humerus commonly result from direct trauma to the elbow or fall on an outstretched hand with the elbow in > 110 degrees of flexion.…”

“…34,35 Numerous authors have emphasized that even though parallel plating offers the advantages of increased stability and allowing placement of a long screw to bridge the lateral to medial column distally, both perpendicular and parallel plating offer enough stability to permit early mobilization and adequate fracture healing. 17,31,34 A study of 38 patients comparing the two techniques showed no difference in range of motion or function (although two patients in the perpendicular plating group resulted in nonunion that did not occur with any patients in the parallel plating group). 36 Some surgeons thus advocate using parallel plating for distal fracture patterns to maximize distal fixation.…”

“…Olecranon osteotomy is the traditional standard approach and provides the greatest exposure to the articular surface. 17,37 The osteotomy is performed at the deepest portion of the trochlear notch at the bare area to avoid damage to the articular cartilage. 38 A chevron-shaped osteotomy is performed with the chevron pointing distally, and the osteotomized olecranon and triceps are reflected superiorly to gain exposure to the distal humeral articular surface.…”

Distal Humeral Hemiarthroplasty Versus Total Elbow Arthroplasty for Acute Distal Humeral Fractures

“…A dult distal humeral fractures are relatively rare injuries, comprising 2% to 5% of all fractures and 30% of all elbow fractures. 1,2 A bimodal age and sex distribution has been reported consisting of high-energy injuries in younger males and low-energy falls in elderly females with osteoporosis. 1,2 The majority of these fractures have a reconstructable intra-articular component (AO/ OTA type 13-B or 13-C), 1,3 making open reduction and internal fixation (ORIF) the treatment of choice.…”