What is the treatment for a distal humerus (upper arm bone) fracture?

From the Research

Treatment Options for Distal Humerus Fractures

The treatment for distal humerus fractures can vary depending on the severity and complexity of the fracture. The following options are available:

• Nonoperative management, which is typically reserved for lower-demand, medically unwell, elderly patients 1
• Surgical osteosynthesis, which remains the treatment of choice for most fractures 1
• Prosthetic replacement with either hemiarthroplasty or total elbow arthroplasty, which is indicated for distal complex comminuted fracture patterns in elderly, low-demand patients with poor bone quality 1

Surgical Approaches

Different surgical approaches can be used to treat distal humerus fractures, including:

• Posterior midline triceps-splitting approach 2
• Triceps-splitting approach with the patient in supine decubitus position 2
• Olecranon osteotomy approach 2
• Lateral approach 2

Goals of Surgical Treatment

The goals of surgical treatment for distal humerus fractures are:

• Anatomical restoration of the articular surface 3, 4
• Stable fixation of the fracture fragments to allow for early motion 3, 4
• Reconstruction of the articular surface if needed 3
• Stability and rigidity of the fixation 3

Challenges and Controversies

The treatment of distal humerus fractures can be challenging due to:

• Anatomic complexity 5
• Multifragmentary comminution 5
• Short distal segment 5
• Osteoporotic bone 5
• Controversies exist in the areas of surgical approach, management of the ulnar nerve, plating technique, and whether osteosynthesis or prosthetic elbow replacement is superior in the elderly population 1