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Distal Humerus Fracture

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Updated Sep 20264 citations

What you're feeling

A distal humerus fracture is a break at the bottom end of the arm bone, just above the elbow. It usually happens from a fall onto the arm or a direct knock to the elbow. Many people feel or hear a snap at the moment of injury.

The pain is usually immediate and strong. Your elbow may swell quickly, and bruising often appears over the next day or two. The arm may look out of shape at the elbow if the bone ends have shifted. You will probably not want to move the arm, and simple tasks like getting dressed, eating, or pushing up from a chair become hard.

These breaks are uncommon. They make up about 0.5% of all fractures in adults. They become more likely with age, especially after 50, and rise sharply in people over 80. They happen more often in women, and they are linked to thinning of the bones (osteoporosis).

In the first days, the pain is often worse with movement and at night. Keeping the arm still helps early on. Over the first couple of weeks, the pain usually starts to settle, though the elbow will stay stiff and tender for some time.

Most of these breaks break through the joint surface, which is why treatment usually involves surgery to hold the bone in place while it heals. Your surgeon will talk you through the options, which depend on the break pattern and your general health.

What's actually happening

The bottom of your arm bone widens just above the elbow into two rounded ends. One end lines up with the bone of your forearm on the thumb side, and the other end lines up with the forearm bone on the little finger side. Together they form a hinge that lets your elbow bend and straighten, and a pivot that lets you turn your palm up and down.

A break here is more than a crack in a straight tube. The bone at this spot is thin in the middle, which lets the elbow move freely but leaves a weak point. When you fall onto the arm, the force funnels into this thin area and can split it into pieces. If the break runs into the joint surface, the smooth lining that lets the two bones glide becomes uneven. The pieces can also shift apart, so the elbow no longer lines up and cannot carry load or move the way it did.

Think of a door hinge bolted to a frame. If the hinge plate cracks and the screw holes loosen, the door still hangs there but it drops, catches, and will not swing cleanly. Your elbow is in that state right now: the parts are connected, but the joint that should guide them is broken.

Bone heals by knitting back together, as long as the pieces are held still and close to where they started. Ligaments, the strong straps that hold the bones together, can also heal if the ends are held in place. When the pieces have shifted or the joint surface is broken into several fragments, the arm cannot hold itself still, so surgery is usually needed to hold everything in position while it heals. If the pieces are too small or too crushed to hold together, replacing the broken half of the joint may be discussed instead.

What we can do about it

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, matches the treatment to your specific 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. At that first visit we take a history, examine your elbow, and arrange X-rays from several angles. If the break pattern is unclear, a CT scan builds a detailed picture of the bone pieces to help plan treatment.

Some breaks are stable and the pieces have not shifted. For these, or when surgery would carry more risk than benefit for you, we may treat the arm without an operation. That means resting the arm in a sling, splint or cast, and checking the bone position with repeat imaging as it heals. Movement returns in stages, guided by physiotherapy.

Surgery is often recommended from the start. Most of these breaks run through the joint surface, and if the pieces have shifted or the elbow feels unstable, holding them in place with plates and screws lets the bone heal in the right shape. We usually aim for a repair strong enough that you can start moving early. If the bone is too crushed or thin to hold a repair, replacing part or all of the elbow joint may be the better choice, especially for older, less active patients. Sometimes both paths are possible, and the choice is genuinely shared: non-operative care avoids an operation, but the pain during healing or the final position of the elbow may not suit you. We will talk through what matters to you and decide together.

Whichever path you take, the first weeks follow a similar course. Pain relief keeps you comfortable while the bone settles. The injury needs protecting as it heals, so we will tell you what your arm can and cannot do. Physiotherapy starts at the right stage for your injury, restoring bend, straightening and rotation as the bone becomes strong enough to trust.

What to expect

Healing takes time. The bone knits together over weeks, and the elbow stays stiff and tender while that happens. Most people find the pain settles first, then movement returns in stages as physiotherapy works on bend, straightening and turning the forearm. The goal of treatment is a stable elbow that can move early and reach a full range of motion.

If your arm is treated without surgery, the break is held still in a sling, splint or cast while it heals, and the position is checked with repeat scans. If you have surgery, plates and screws hold the pieces in the right shape while they knit. Repair strong enough to allow early movement is linked with better results for breaks that run through the joint surface. For older patients, repairs using two plates on either side of the bone have shown good function, with complication rates in line with what is usually reported. When the bone is too crushed to repair, replacing part of the joint can also give good function and movement.

Recovery is not always smooth. The pieces can heal in a poor position, which is called malunion, and this is a common problem after these breaks. It is influenced by the biology of the bone, how well the pieces line up, how they are held, and whether the repair holds. The pieces can also fail to knit at all. Thin bones raise the risk of the repair failing mechanically, and smoking is linked with poorer bone quality, so we will ask about it. Stiffness is expected early and physiotherapy works against it. If the joint surface was badly damaged and the elbow stays painful, replacing the whole joint later on is an option, though it carries more complications than doing it at the time of injury.

For older adults, these injuries are serious. Deaths at 1 and 2 years after an isolated distal humerus fracture are substantial, and are strongly linked with other health conditions and how well you walked before the injury. We take your overall health into account when planning treatment.

When to see someone

Seek urgent care if your arm looks out of shape at the elbow, if there is an open wound, if your fingers feel numb or tingly, or if you cannot use the arm at all. These signs need checking straight away. If you have already been seen but the pain is not settling, or the swelling, movement or use of your arm are not improving week on week as the bone heals, see your GP or ask for a specialist review. Healing rarely runs in a straight line, but each week should bring some change. If nothing is shifting, it is worth having another look.

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

[11] Distal humerus hemiarthroplasty for complex intra-articular fractures in elderly or nonfixable patients: a meta-analysis of clinical and functional outcomes. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101695

[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

[20] Hemiarthroplasty vs. open reduction and internal fixation for comminuted distal humerus fractures in patients under 65 years: a systematic review. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2025.07.014

[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

[22] Total Elbow Arthroplasty for Distal Humerus Fractures. Hand Clinics. 2015. DOI: 10.1016/j.hcl.2015.06.008

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[29] Surgical treatment for posterior distal humeral shear fractures. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.05.003

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[35] Coronal shear fractures of the distal humerus: the capitellum and trochlea. Hand Clinics. 2004. DOI: 10.1016/j.hcl.2004.08.001

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