Management of distal humerus fractures

Abstract

Distal humeral fractures represent approximately 2% of fractures in adults and are often treated operatively to restore stable humeral columns and allow early elbow motion. Diagnosis is made with orthogonal radiographs. The traction view radiograph and computed tomography with three-dimensional reconstruction can be helpful in preoperative planning. Treatment options include: (1) nonoperative management, which is reserved for lower-demand, medically unwell, elderly patients, (2) surgical osteosynthesis, which remains the treatment of choice for most fractures, and (3) 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. A thorough understanding of the anatomy around the elbow is critical when planning surgical approach and reduction. Controversies exist in the following areas: (1) surgical approach, (2) management of the ulnar nerve, (3) plating technique—parallel versus orthogonal, and (4) whether osteosynthesis or prosthetic elbow replacement is superior in the elderly population.

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Fig. 1

Courtesy of Marc J. Richard, MD [Durham, NC]

Fig. 2

Courtesy of Daphne Beingessner, MD, MSc, FRCSC [Seattle, WA]

Fig. 3

Reproduced with permission from ASSH Textbook of Hand Surgery, 2019

Fig. 4

Reproduced with permission from ASSH Textbook of Hand Surgery, 2019

Fig. 5

Reproduced with permission from ASSH Textbook of Hand Surgery, 2019

Fig. 6

Reproduced with permission from ASSH Textbook of Hand Surgery, 2019

Fig. 7

Reproduced with permission from ASSH Textbook of Hand Surgery, 2019

Fig. 8

Courtesy of Marc J. Richard, MD [Durham, NC]

Fig. 9

A. Courtesy of Marc J. Richard, MD [Durham, NC]: B, C. Courtesy of Douglas P. Hanel, MD [Seattle, WA]: C)

Fig. 10

Courtesy of Marc J. Richard, MD [Durham, NC] (color figure online)

Fig. 11

Courtesy of Marc J. Richard, MD [Durham, NC]

Fig. 12

Courtesy of Marc J. Richard, MD [Durham, NC]

Fig. 13

Courtesy of Daphne Beingessner, MD, MSc, FRCSC [Seattle, WA]

Fig. 14

Courtesy of Marc J. Richard, MD [Durham, NC]

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Acknowledgements

The authors would like to thank Dr. Douglas P. Hanel and Dr. Daphne Beingessner for their case contributions to this manuscript.

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Correspondence to Alexander Lauder.

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The authors disclose no direct or indirect conflicts of interest with publication of the manuscript content. Neither author received funding, grants, or in-kind support in support of the research or preparation of the manuscript. Alexander Lauder, MD, has no potential conflicts of interest. Marc J. Richard, MD, is a consultant to the following implant companies: Acumed, Depuy Synthes, Medartis, Bioventus, Exomed, and DJO, but did not receive any funding or support for publication of this manuscript.

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Lauder, A., Richard, M.J. Management of distal humerus fractures. Eur J Orthop Surg Traumatol 30, 745–762 (2020). https://doi.org/10.1007/s00590-020-02626-1

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Keywords

  • Distal humerus fractures
  • Plating technique
  • Prosthetic replacement
  • Trauma
  • Ulnar nerve management