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Distal Humerus Fracture

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Updated Aug 20264 citations

What you're feeling

You may hear or feel a snap or pop at the moment of injury. This often happens after a fall, a direct impact, or a sudden heavy load on your arm. The pain is usually sharp and immediate. It centres in your elbow and can radiate down your forearm or up into your upper arm.

Your elbow will likely swell quickly. Bruising may appear on the skin around the joint within hours. You might notice a visible change in the shape of your arm, known as deformity, as the broken bone ends shift out of place. Moving the arm feels difficult and painful. You may find yourself holding your elbow still to avoid triggering more pain.

In the first few days, the pain can be constant. It often worsens at night or when you try to rest the arm in certain positions. Simple tasks become challenging. You might struggle to lift a cup of tea, open a door handle, or support your weight if you need to stand up from a chair using your arms. Even slight movement of the elbow joint can feel stiff and sore.

As healing begins over the first few weeks, the sharp pain gradually settles into a duller ache. Swelling may persist but should slowly reduce. You will still feel stiffness when you try to bend or straighten your elbow. Night-time discomfort may lessen, allowing for better sleep, though you may still need to adjust your position to keep the arm supported.

It is important to remember that outcomes for these fractures can vary. Your surgeon will guide you based on the specific nature of your break and your overall health. For older adults, recovery involves careful monitoring of general well-being alongside the arm injury. In younger patients, the focus is often on restoring full function through precise repair.

Throughout this early phase, your experience is unique. Some people find pain management straightforward, while others need more support. Your surgeon will tailor your care plan to your needs, ensuring you have the right support to manage discomfort as your body starts the healing process.

What's actually happening

Your distal humerus is the lower part of your upper arm bone, right where it meets your elbow. This area is complex because it forms the hinge of your elbow joint. When you suffer a fracture here, the smooth surfaces that allow your arm to bend and straighten can become damaged or displaced. This disruption means the joint no longer glides correctly, causing pain and limiting movement.

Think of your elbow like a door hinge. The distal humerus is the metal bracket that holds the hinge pins in place. If that bracket cracks or shifts out of alignment, the door (your forearm) cannot swing smoothly. It might stick, wobble, or lock up entirely. This mechanical instability is why your arm feels weak and painful right now.

Healing this injury requires more than just bone knitting back together. Your surgeon aims to restore the precise alignment of the joint surface, often described as the 'triangle of stability'. This structural integrity is crucial for ensuring your elbow remains stable during early movement. If the bone fragments are displaced, they must be carefully repositioned and held in place with internal fixation, such as plates and screws, to keep everything aligned while the bone heals.

In some cases, the damage is too severe for standard repair. If the joint surface is excessively worn or shattered, your surgeon might discuss alternative options. These can include replacing the damaged part of the joint with a prosthetic component (hemiarthroplasty) or, in specific elderly patients with low physical demands, a total elbow replacement. These approaches aim to restore function when natural bone reconstruction is not viable.

Complications like malunion (healing in a poor position) or nonunion (failure to heal) can occur. These are influenced by the quality of the initial reduction and the stability of the fixation. Your surgeon will select the approach that best balances evidence-based outcomes with your individual needs, ensuring the best possible chance for a stable, functional elbow.

What we can do about it

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. If your fracture is stable or only slightly displaced, we may recommend non-operative care. This involves wearing a sling, splint, or cast to keep the arm still while the bone heals. We monitor your progress with repeat imaging to ensure the bones stay in the correct position. You will gradually begin moving your elbow again with the help of physiotherapy, following a staged plan that protects the healing bone.

Surgery is often the best choice from the start if your fracture is displaced, unstable, or involves the joint surface. We recommend internal fixation to hold the bone fragments together with plates and screws, allowing you to move your elbow early. For complex fractures in elderly patients where the bone cannot be fixed, we may suggest replacing part of the joint (hemiarthroplasty). This decision is shared between us, considering your pain levels, functional needs, and the stability of the injury. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. A clinic assessment establishes the diagnosis. For acute problems like this, surgery may be recommended straight away.

Both paths share common goals in the early weeks. You will need effective pain control to manage discomfort while the injury settles. Protecting the arm from heavy lifting or sudden movements is crucial while the bone heals. Physiotherapy plays a key role in both approaches, helping you regain strength and range of motion at the right stage. For children, we focus on restoring the natural alignment of the elbow to ensure full movement later. If you have risk factors like smoking or poor bone quality, we discuss these openly to plan your care safely. Our aim is to give you the best chance of a stable, functional elbow, whether we use fixation or joint replacement.

What to expect

Your recovery depends on whether your surgeon can repair the bone or needs to replace the joint surface. If you have a fracture that can be fixed with plates and screws, your surgeon will hold the pieces together while they heal. For older patients with complex breaks that cannot be repaired, joint replacement is a viable option. This involves replacing the damaged end of the humerus bone with a metal implant.

Healing takes time. For those having bone repair, the bone typically takes several weeks to knit together. You will need to keep your arm supported initially. If you have a joint replacement, the implant provides immediate stability, but soft tissues still need time to settle. Most patients find that daily tasks become easier over the first few months as swelling goes down and movement improves.

Outcomes are generally good for both paths. Older patients having bone repair with parallel plates show good functional results. Those having joint replacement also report good to excellent outcomes. However, you should be aware of potential complications. The bone may heal in a poor position, known as malunion, or fail to heal at all, known as nonunion. These risks are higher if you have poor bone quality or smoke. Stiffness is also common. In some cases, particularly with intra-articular fractures in older adults, the joint may progress to needing replacement later; nearly 5.5% of such patients require this by 10 years.

Return to normal activity varies. Younger patients often return to full duty and sport after bone repair. Older adults should expect a slower pace. Your surgeon will guide you on when it is safe to lift or push. Be aware that mortality at one and two years is substantial for older adults with these fractures, strongly linked to other health conditions and how mobile you were before the injury. Your surgeon will discuss these risks with you to ensure the chosen path matches your health and lifestyle goals.

When to see someone

Seek urgent care if you have an open wound, visible deformity, numbness or tingling, or cannot use your arm. These signs need immediate assessment. If your pain is not settling, or if swelling and movement are not improving week on week as healing progresses, see your GP. Ask for a specialist review to check your recovery. Your surgeon will guide you on the next steps. Early attention helps manage risks like poor bone healing or joint stiffness. Do not wait for symptoms to worsen. Regular check-ins ensure your treatment plan matches how your body is responding.

Advanced reading: the deeper science (optional)

This section goes further than you need for your own treatment decisions. A distal humerus fracture is worth the extra reading because it sits at an awkward junction: it is one of the more complication-prone fractures in the upper limb, the standard surgical exposure involves deliberately breaking a second bone, and in older patients the case for operating at all is less settled than you might assume.

The complication rate is higher than the reputation

The largest pooled analysis of intra-articular distal humeral fractures treated by open reduction and internal fixation gathered 2,362 patients, and its conclusion was blunt: complications and reoperations are more frequent than previously understood [1].

That is a useful corrective. These fractures are usually presented as difficult but solvable, and the technical result on an X-ray is often excellent. The gap between a good radiograph and a good elbow is wider here than almost anywhere else in the limb, and the literature had been under-reporting it.

The exposure has its own cost

To see the joint surface properly, the usual approach detaches the olecranon by cutting across it — an olecranon osteotomy — and repairs it at the end. It is an elegant solution to a real problem of access, and it is not free.

Pooling 1,700 osteotomies, 447 complications were reported. Wound infection occurred in 4.2% and problems with the osteotomy uniting in 3.7% [2]. So a decision to use this exposure is a decision to accept a small but definite chance of a second problem at a site that was intact before surgery. The authors' framing is the right one: the risk must be part of the decision to perform the osteotomy, not a footnote to it.

For what it is worth, the choice between posterior exposures appears to matter less than the decision to use one. A meta-analysis of 1,258 patients with complete intra-articular (AO/OTA type C) fractures compared olecranon osteotomy against triceps-reflecting, triceps-splitting and triceps-sparing approaches and found comparable overall outcomes, with most measures showing no statistically significant difference [3].

In older patients the question is genuinely open

There is a strong instinct that a displaced intra-articular fracture must be fixed. In older adults that instinct is not well supported by comparative data.

A systematic review of 1,838 older patients compared surgical and non-surgical management and found that each of the treatment modalities studied produced a reasonable level of elbow function [4]. The authors are careful about why that is not a recommendation to stop operating: the included studies were largely non-comparative and carried considerable risk of bias. It is an absence of evidence for superiority rather than evidence of equivalence.

Still, the practical implication holds. For a frail patient with low functional demand, a plan built around comfort and early movement rather than anatomical reconstruction is a defensible choice supported by outcomes that are not obviously worse — and it avoids every complication described above.

What this means for you

Three things follow. Expect the recovery to be about motion, not bone healing — the bone is the easy part. Ask specifically what exposure is planned and what it commits you to. And if you are older, or have limited demands on the arm, ask directly whether non-operative treatment is reasonable in your case, because the honest answer may be yes.

Reviewed by Dr Kieran Hirpara · 13 August 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

References for the advanced reading
  1. Yetter TR, Weatherby PJ, Somerson JS. Complications of articular distal humeral fracture fixation: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2021;30(8):1957-67.
  2. Spierings KE, Schoolmeesters BJ, Doornberg JN, Eygendaal D, van den Bekerom MP. Complications of olecranon osteotomy in the treatment of distal humerus fracture. Clin Shoulder Elb. 2022;25(2):163-9.
  3. Yao H, Chen W, Lin Z, Cao H. Comparative efficacy and safety of different posterior surgical approaches for intra-articular distal humerus fractures. J Orthop Surg Res. 2026;21(1).
  4. Stoddart MT, Panagopoulos GN, Craig RS, Falworth M, Butt D, Rudge W, et al. A systematic review of the treatment of distal humerus fractures in older adults: a comparison of surgical and non-surgical options. Shoulder Elbow. 2022;16(2):175-85.
Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Reported outcomes for acute distal humerus fractures remain inconsistent across the orthopedic literature, making it difficult for surgeons to retrospectively compare surgical techniques and clinical outcomes across studies [3].
  • The systematic review cited is the largest report of complications and reoperations of intra-articular distal humeral fractures after ORIF in the current literature [9].
  • Decision regarding the treatment for intra-articular fractures of the distal humerus should be based on a combination of the best available evidence and preference of the surgeon [7].
  • Open reduction and internal fixation is a viable treatment option for distal humeral fractures in the elderly, but careful patient selection is required [14].
  • Older patients who underwent ORIF of the distal humerus using a parallel construct demonstrated good functional outcomes and similar complications to those in previously reported studies [1].
  • For comminuted distal humerus fractures in young patients, ORIF appears to be the preferred surgical option, offering superior functional outcomes and a lower incidence of complications and heterotopic ossification [20].
  • Total elbow arthroplasty provides a successful treatment alternative for selected distal humerus fractures, particularly in elderly patients with low anticipated physical demands, severe osteopenia, or comminution [22].
  • Distal humerus hemiarthroplasty is a viable option in the treatment of unreconstructible distal humerus fractures, with good to excellent outcomes expected [2].
  • Distal humeral hemiarthroplasty is a suitable option for unreconstructable distal humeral fractures and offers good functional outcomes with acceptable complication rates [8].
  • Elbow hemiarthroplasty is a viable option for complex distal humeral fractures in select patients, offering functional outcomes comparable to total elbow arthroplasty while potentially avoiding complications related to the ulnar component [15].
  • Open reduction and internal fixation with bone grafting is the treatment of choice for nonunion of distal humerus fractures if no excessive damage of the articular surface is present [5].

Anatomy & Pathophysiology

  • Malunion of distal humerus fractures is a common complication influenced by biology, reduction quality, fixation methods, and mechanical failure [6].
  • Posterior shear fractures of the distal humerus mostly involve the posterior aspect of the capitellum and are often associated with elbow dislocation [29].
  • Precontoured locking plates may have geometric limitations in specific complex morphologies of coronal shear fractures, supporting individualized hybrid fixation strategies [27].
  • Anatomic reduction with sufficient stability to allow for early joint mobilization is a general principle for the treatment of coronal shear fractures involving the capitellum and trochlea [35].
  • Management principles for pediatric distal humerus fractures focus on restoring the anatomic axis, the triangle of stability, and the articular surface to ensure a stable elbow joint that allows for early motion and full range of motion [4].
  • There is a lack of consensus on defining and diagnosing different types of ulnar nerve dysfunction in distal humerus fractures [31].

Classification

  • The Dubberley classification is useful in describing coronal shear fractures of the distal humerus and selecting the surgical approach [30].
  • Outcomes for capitellum fractures are unclear due to multiple classification systems and a literature consisting of small case series without comparative groups [34].

Clinical Presentation

  • Older adults with isolated distal humerus fractures have substantial mortality at 1 and 2 years, which is strongly predicted by comorbidity burden and preinjury ambulation [17].
  • Malunion is a common complication after distal humerus fractures, influenced by biology, reduction, fixation methods, and mechanical failure [6].
  • The management of distal humerus fractures remains problematic, particularly in elderly patients with osteoporosis and comminution where ORIF may be impossible [18].

Investigations

  • A thorough smoking history and CT Hounsfield Unit measurements in the coronal plane may identify patients with poorer bone quality at higher risk for postoperative mechanical complications following distal humerus fracture fixation [21].

Treatment

  • Open reduction and internal fixation (ORIF) using parallel precontoured plates demonstrates good functional outcomes and complication rates similar to previously reported studies in elderly patients [1].
  • Distal humerus hemiarthroplasty is a viable treatment option for unreconstructible distal humerus fractures, with good to excellent outcomes expected [2].
  • Reported outcomes for acute distal humerus fractures remain inconsistent across the orthopedic literature, complicating retrospective comparisons of surgical techniques and clinical outcomes [3].
  • Decision-making regarding the treatment for intra-articular fractures of the distal humerus should be based on a combination of the best available evidence and surgeon preference [7].
  • Distal humeral hemiarthroplasty is a suitable option for unreconstructable distal humeral fractures, offering good functional outcomes with acceptable complication rates [8].
  • A systematic review provides the largest report of complications and reoperations of intra-articular distal humeral fractures after ORIF in the current literature [9].
  • Complete distal humerus fractures are treated using a posterior approach with dual plating, while elbow arthroplasty may be indicated for selected patients with severely comminuted fractures and osteoporotic bone [10].
  • Distal humerus hemiarthroplasty yields satisfactory functional outcomes and range of motion in complex distal humerus fractures not amenable to fixation, particularly in elderly patients [11].
  • Both orthogonal and parallel plating techniques can be used to treat distal humerus fractures with excellent outcomes [12].
  • Salvage total elbow arthroplasty (TEA) is a viable option for managing post-traumatic sequelae following distal humeral fracture treatment, but patients undergoing salvage TEA have a significantly increased rate of complications and significantly inferior functional outcomes compared to those undergoing acute TEA [13].
  • Open reduction and internal fixation is a viable treatment option for distal humeral fractures in the elderly, requiring careful patient selection [14].
  • Internal fixation is generally accepted as the standard of care for intra-articular distal humerus fractures, with rigid anatomic fixation combined with early motion associated with favorable results [16].
  • Management of distal humeral fractures remains problematic in elderly patients with osteoporosis and comminution where ORIF may be impossible [18].
  • Orthopedic (OO), triceps-reflecting anconeus (TRA), triceps-splitting (TS), and triceps-turning (TT) posterior approaches provide comparable overall clinical outcomes in the management of AO/OTA type C complete intra-articular distal humerus fractures, with most outcome measures showing no statistically significant differences [19].
  • Total elbow arthroplasty constitutes a viable treatment option for complex distal humeral fractures in elderly and medically compromised patients [38].

Complications

  • Older patients undergoing ORIF of the distal humerus using a parallel construct demonstrate good functional outcomes and similar complication rates to those in previously reported studies [1].
  • Distal humerus hemiarthroplasty is a viable option for unreconstructible distal humerus fractures, with good to excellent outcomes expected [2].
  • Management principles for unusual pediatric distal humerus fracture patterns focus on restoring the anatomic axis, the triangle of stability, and the articular surface to ensure a stable elbow joint that allows for early motion and full range of motion [4].
  • This systematic review represents the largest report of complications and reoperations of intra-articular distal humeral fractures after ORIF in the current literature [9].
  • Salvage total elbow arthroplasty (TEA) is a viable option for managing post-traumatic sequelae following distal humeral fracture treatment, although patients undergoing salvage TEA have a significantly increased rate of complications and significantly inferior functional outcomes compared with those who undergo acute TEA [13].
  • In older adults with isolated distal humerus fractures, mortality at 1 and 2 years is substantial and strongly predicted by comorbidity burden and preinjury ambulation [17].
  • A thorough smoking history and CT Hounsfield Unit (HU) measurements in the coronal plane may identify patients with poorer bone quality at higher risk for postoperative mechanical complications following distal humerus fracture fixation [21].
  • The high risk of complications in olecranon osteotomy must be considered in the decision to perform this procedure in the treatment of distal humerus fractures [39].

Recovery

  • Older patients undergoing open reduction and internal fixation (ORIF) of the distal humerus using a parallel precontoured plate construct demonstrate good functional outcomes [1].
  • Complication rates for elderly patients treated with parallel plate ORIF are similar to those reported in previously published studies [1].
  • Distal humerus hemiarthroplasty is a viable treatment option for unreconstructible distal humerus fractures [2].
  • Patients treated with distal humerus hemiarthroplasty for trauma can expect good to excellent outcomes [2].
  • Reported outcomes for acute distal humerus fractures are inconsistent across the orthopedic literature [3].
  • Outcome inconsistency in the literature hinders retrospective comparison of surgical techniques and clinical outcomes across studies [3].
  • Management of pediatric distal humerus fractures focuses on restoring the anatomic axis, the triangle of stability, and the articular surface [4].
  • Restoration of anatomic alignment and stability in pediatric distal humerus fractures is intended to ensure a stable elbow joint that allows for early motion and full range of motion [4].
  • Malunion is a common complication following distal humerus fractures [6].
  • Malunion risk is influenced by biology, reduction quality, fixation methods, and mechanical failure [6].
  • Distal humeral hemiarthroplasty is a suitable option for unreconstructable distal humeral fractures [8].
  • Distal humeral hemiarthroplasty offers good functional outcomes with acceptable complication rates [8].
  • Distal humerus hemiarthroplasty yields satisfactory functional outcomes and range of motion in complex distal humerus fractures not amenable to fixation [11].
  • Distal humerus hemiarthroplasty is particularly effective for complex fractures in elderly patients [11].
  • Salvage total elbow arthroplasty (TEA) is a viable option for managing post-traumatic sequelae of distal humeral fractures [13].
  • Patients undergoing salvage TEA have a significantly increased rate of complications compared to those undergoing acute TEA [13].
  • Patients undergoing salvage TEA have significantly inferior functional outcomes compared to those undergoing acute TEA [13].
  • Elbow hemiarthroplasty is a viable option for complex distal humeral fractures in select patients [15].
  • Elbow hemiarthroplasty provides functional outcomes comparable to total elbow arthroplasty [15].
  • Elbow hemiarthroplasty may avoid complications related to the ulnar component compared to total elbow arthroplasty [15].
  • Mortality at 1 and 2 years is substantial in older adults with isolated distal humerus fractures [17].
  • Mortality in older adults with isolated distal humerus fractures is strongly predicted by comorbidity burden and preinjury ambulation [17].
  • Smoking history and CT Hounsfield Unit (HU) measurements in the coronal plane can identify patients with poorer bone quality [21].
  • Patients identified with poorer bone quality via smoking history and CT HU measurements are at higher risk for postoperative mechanical complications following distal humerus fracture fixation [21].
  • In older cohorts, intra-articular distal humerus fractures are associated with a more than two-fold increased risk of progressing to TEA compared to extra-articular fractures [41].
  • The increased risk of TEA for intra-articular versus extra-articular fractures in older patients is observed at every time point studied [41].
  • Nearly 5.5% of older patients with distal humerus fractures progress to TEA by 10 years [41].
  • Long-term results of well-performed ORIF demonstrate satisfactory outcomes in most patients with bicolumnar distal humerus fractures [42].
  • TEA yields encouraging results as a primary treatment for carefully selected comminuted distal humerus fractures in elderly patients [43].
  • TEA is particularly indicated for elderly patients with comminuted distal humerus fractures who also have significant rheumatoid arthritic changes [43].

Key Evidence

  • [L4] Older patients who underwent ORIF of the distal humerus using a parallel construct demonstrated good functional outcomes and similar complications to those in previously reported studies. [1] (10.1016/j.jhsa.2022.01.030)
  • [L4] Distal humerus hemiarthroplasty is a viable option in the treatment of unreconstructible distal humerus fractures, with good to excellent outcomes expected. [2] (10.1016/j.jse.2022.02.015)
  • [L1] Reported outcomes for acute distal humerus fractures remain inconsistent across the orthopedic literature, making it difficult for surgeons to retrospectively compare surgical techniques and clinical outcomes across studies. [3] (10.1016/j.otsr.2018.08.017)
  • [L5] Management principles focus on restoring the anatomic axis, the triangle of stability, and the articular surface to ensure a stable elbow joint that allows for early motion and full range of motion. [4] (10.5435/jaaos-d-17-00326)
  • [L5] Open reduction and internal fixation with bone grafting is the treatment of choice for nonunion of distal humerus fractures if no excessive damage of the articular surface is present. [5] (10.1016/j.jisako.2024.07.002)
  • [L5] Malunion is a common complication after distal humerus fractures influenced by biology, reduction, fixation methods, and mechanical failure. [6] (10.1016/j.jisako.2024.05.009)
  • [L5] Decision regarding the treatment for intra-articular fractures of the distal humerus should be based on a combination of the best available evidence and preference of the surgeon. [7] (10.5397/cise.2019.22.2.113)
  • [L4] Distal humeral hemiarthroplasty is a suitable option for unreconstructable distal humeral fractures and offers good functional outcomes with acceptable complication rates. [8] (10.1177/17585732211023100)
  • [L1] This systematic review is the largest report of complications and reoperations of intra-articular distal humeral fractures after ORIF in the current literature. [9] (10.1016/j.jse.2021.02.017)
  • [L4] Complete fractures are treated using a posterior approach with dual plating, while elbow arthroplasty may be indicated for selected patients with severely comminuted fractures and osteoporotic bone. [10] (10.1016/j.otsr.2013.11.002)
  • [L1] DHH yields satisfactory functional outcomes and range of motion in complex distal humerus fractures not amenable to fixation, particularly in elderly patients. [11] (10.1016/j.jseint.2026.101695)
  • [L5] Distal humerus fractures are complex, and both orthogonal and parallel plating techniques can be used to treat these difficult fractures with excellent outcomes. [12] (10.1016/j.hcl.2010.05.008)
  • [L1] Salvage TEA represents a viable option for the management of post-traumatic sequelae following the treatment of a distal humeral fracture, although patients who underwent salvage TEA had a significantly increased rate of complications and significantly inferior functional outcomes compared with those who underwent TEA acutely. [13] (10.1302/0301-620x.108b1.bjj-2025-0475.r1)
  • [Paper] Open reduction and internal fixation is a viable treatment option for distal humeral fractures in the elderly, but careful patient selection is required. [14] (10.1016/j.injury.2007.08.006)
  • [L4] Elbow hemiarthroplasty is a viable option for complex distal humeral fractures in select patients, offering functional outcomes comparable to total elbow arthroplasty while potentially avoiding complications related to the ulnar component. [15] (10.1177/1758573216640210)
  • [L5] Internal fixation is generally accepted as the standard of care for the treatment of intra-articular distal humerus fractures, with rigid anatomic fixation combined with early motion associated with favorable results. [16] (10.1016/j.hcl.2007.09.001)
  • [L3] In older adults with isolated distal humerus fractures, mortality at 1 and 2 years is substantial and strongly predicted by comorbidity burden and preinjury ambulation. [17] (10.1016/j.jse.2026.02.013)
  • [L5] The management of distal humeral fractures remains problematic, particularly in elderly patients with osteoporosis and comminution where ORIF may be impossible. [18] (10.1016/j.jse.2010.11.012)
  • [L1] Current evidence indicates that OO, TRA, TS, and TT posterior approaches provide comparable overall clinical outcomes in the management of AO/OTA type C complete intra-articular distal humerus fractures, with most outcome measures showing no statistically significant differences. [19] (10.1186/s13018-026-06739-x)
  • [L4] For comminuted distal humerus fractures in young patients, ORIF appears to be the preferred surgical option, offering superior functional outcomes and a lower incidence of complications and heterotopic ossification. [20] (10.1016/j.xrrt.2025.07.014)
  • [L3] A thorough smoking history and CT HU measurements in the coronal plane may identify patients with poorer bone quality at higher risk for postoperative mechanical complications following distal humerus fracture fixation. [21] (10.5435/jaaos-d-26-00191)
  • [L4] Total elbow arthroplasty provides a successful treatment alternative for selected distal humerus fractures, particularly in elderly patients with low anticipated physical demands, severe osteopenia, or comminution. [22] (10.1016/j.hcl.2015.06.008)
  • [L4] Precontoured locking plates may have geometric limitations in specific complex morphologies, supporting individualized hybrid fixation strategies. [27] (10.1186/s12891-026-09582-7)
  • [L4] Posterior shear fractures of the distal humerus mostly involve the posterior of the capitellum and are often associated with elbow dislocation. [29] (10.1016/j.jse.2026.05.003)
  • [L4] The study confirms the utility of the Dubberley classification in describing the fracture and selecting the surgical approach. [30] (10.1016/j.jse.2025.05.033)
  • [L5] There is a lack of consensus on defining and diagnosing different types of ulnar nerve dysfunction, necessitating prospective studies with standardized definitions. [31] (10.1016/j.jhsa.2011.11.023)
  • [L4] The article summarizes the existing body of evidence on capitellum fractures, noting that outcomes are unclear due to multiple classification systems and a literature consisting of small case series without comparative groups, and proposes areas for future study. [34] (10.1177/1558944719878817)
  • [L4] Anatomic reduction with sufficient stability to allow for early joint mobilization is a general principal for treatment. [35] (10.1016/j.hcl.2004.08.001)
  • [L4] Total elbow arthroplasty constitutes a viable treatment option for complex distal humeral fractures in elderly and medically compromised patients. [38] (10.1016/j.injury.2009.01.123)
  • [L2] The high risk of complications in olecranon osteotomy must be considered in the decision to perform this procedure in the treatment of distal humerus fractures. [39] (10.5397/cise.2021.00591)
  • [L4] In the older cohort, intra-articular fractures were consistently and temporally associated with a more than two-fold increased risk of TEA compared with extra-articular fractures at every time point studied, with nearly 5.5% of patients progressing to TEA by 10 years. [41] (10.1177/17585732261451863)
  • [L5] Long-term results of well-performed open reduction and internal fixation demonstrate satisfactory outcomes in most patients. [42] (10.5435/00124635-201001000-00004)
  • [L4] Encouraging results have been reported using TEA as a primary mode of treatment for carefully selected comminuted distal humerus fractures in elderly patients, particularly if the patient also has significant rheumatoid arthritic changes. [43] (10.1016/j.hcl.2004.06.006)

References

[1] The Outcomes of Intra-Articular Distal Humerus Open Reduction and Internal Fixation Using Parallel Precontoured Plates in the Elderly. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.01.030

[2] Distal humerus hemiarthroplasty for trauma: a systematic review of the outcomes and complications. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.02.015

[3] Outcomes of distal humerus fractures: What are we measuring?. Orthopaedics & Traumatology: Surgery & Research. 2018. DOI: 10.1016/j.otsr.2018.08.017

[4] Approaching Unusual Pediatric Distal Humerus Fracture Patterns. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-17-00326

[5] Nonunion of distal humeral fractures: Current concepts. Journal of ISAKOS. 2024. DOI: 10.1016/j.jisako.2024.07.002

[6] Malunion of distal humeral fractures: Current concepts. Journal of ISAKOS. 2024. DOI: 10.1016/j.jisako.2024.05.009

[7] Surgical Treatment Strategy for Distal Humerus Intra-articular Fractures. Clinics in Shoulder and Elbow. 2019. DOI: 10.5397/cise.2019.22.2.113

[8] Outcomes and complications of distal humeral hemiarthroplasty for distal humeral fractures – A systematic review. Shoulder & Elbow. 2021. DOI: 10.1177/17585732211023100

[9] Complications of articular distal humeral fracture fixation: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.02.017

[10] Articular fractures of the distal humerus. Orthopaedics & Traumatology: Surgery & Research. 2014. DOI: 10.1016/j.otsr.2013.11.002

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[12] Use of Orthogonal or Parallel Plating Techniques to Treat Distal Humerus Fractures. Hand Clinics. 2010. DOI: 10.1016/j.hcl.2010.05.008

[13] Total elbow arthroplasty for the management of post-traumatic sequelae of distal humeral fractures. The Bone & Joint Journal. 2026. DOI: 10.1302/0301-620x.108b1.bjj-2025-0475.r1

[14] Management of distal humeral fractures in the elderly. Injury. 2007. DOI: 10.1016/j.injury.2007.08.006

[15] Elbow hemiarthroplasty for the management of distal humeral fractures: current technique, indications and results. Shoulder & Elbow. 2016. DOI: 10.1177/1758573216640210

[16] Distal Humerus Fractures. Hand Clinics. 2007. DOI: 10.1016/j.hcl.2007.09.001

[17] Predictors of mortality after isolated distal humerus fractures in older adults. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.02.013

[18] Distal humeral fractures: fixation versus arthroplasty. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.11.012

[19] Comparative efficacy and safety of different posterior surgical approaches for Intra-articular distal humerus fractures. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-026-06739-x

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[21] Can Computed Tomography Hounsfield Units Predict Distal Humerus Fracture Mechanical Complications?. Journal of the American Academy of Orthopaedic Surgeons. 2026. DOI: 10.5435/jaaos-d-26-00191

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