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Distal Humerus Fracture

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Updated Aug 20264 citations

What you're feeling

You will likely feel deep pain in your elbow and upper arm. This discomfort often radiates down your forearm or up toward your shoulder. The pain is usually most intense right after the injury and may flare up when you try to move the joint. You might notice that the area feels stiff, especially when you first wake up in the morning.

Simple daily tasks can become difficult or impossible. You may struggle to lift even light objects, such as a cup of tea or a mobile phone. Reaching for items on a high shelf or bending your elbow to bring food to your mouth can be painful and limited. You might find it hard to rest your arm comfortably on a table or in your lap without feeling significant pressure or ache.

At night, the pain may worsen, making it hard to find a comfortable sleeping position. You might wake up frequently because any slight movement causes a sharp pang. Swelling and bruising around the elbow are common, which can add to the feeling of tightness and discomfort.

It is important to know that recovery varies. For older adults, the risk of serious health complications is higher, particularly if you have other medical conditions or had difficulty walking before the injury. Younger patients with complex fractures may face challenges with healing and stiffness. Your surgeon will discuss the best treatment plan for you, whether that involves surgery to repair the bone or, in some cases for older patients with severe bone thinning, replacing the joint.

Malunion, where the bone heals in an incorrect position, is a known risk. This can lead to ongoing pain or reduced movement. If the bone does not heal properly (nonunion), further treatment may be needed. Your care team will monitor your progress closely to manage these risks and help you regain function.

What's actually happening

Your elbow is a hinge joint that relies on the smooth meeting of two bone ends. When you fracture the distal humerus, you are breaking the lower end of your upper arm bone where it meets the forearm bones. This area includes the capitellum and trochlea, which act like the rounded knobs on a hinge. These knobs must glide perfectly against each other to allow your arm to bend and straighten.

A fracture here often means the smooth surface is cracked or pushed out of place. In some cases, a piece of bone shears off the back of the joint. This can happen alongside an elbow dislocation, where the joint surfaces are forced out of their normal alignment. The break disrupts the 'triangle of stability' that keeps your elbow steady. Without this stability, the joint becomes loose and painful.

If the broken pieces do not heal in their exact original positions, it is called a malunion. This misalignment changes how the joint moves. It can lead to stiffness, pain, or further damage to the cartilage over time. Your surgeon aims to restore the anatomic axis and the articular surface to ensure a stable elbow that allows for early motion.

In complex cases, the bone may be too shattered to fix with plates and screws alone. This is known as comminution. If the joint surface is severely damaged or the bone quality is poor, particularly in older patients, your surgeon may discuss replacing the damaged part of the joint. This involves removing the broken bone ends and fitting a new surface. This approach helps restore function when reconstruction is not possible.

The goal is always to create a stable joint that lets you move your arm again. Early mobilisation is key to preventing stiffness. However, healing varies. Some patients experience complications like heterotopic ossification, where extra bone forms in the soft tissue around the joint. Others may have ulnar nerve dysfunction, though there is no single consensus on how to define or diagnose this specific nerve issue. Understanding these risks helps you and your surgeon choose the best path for your recovery.

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. 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 (history, examination, and imaging where needed) establishes the diagnosis. For degenerative or long-standing problems we usually try non-operative care — activity change, physiotherapy or hand therapy, splinting, and injections — and consider surgery when that has not given enough improvement. For structural or acute problems, surgery may be recommended straight away, without a preceding non-operative trial.

In the early stages, your priority is to protect the elbow and manage pain. We may advise you to rest the arm and use a splint to keep it stable while the bone begins to heal. Physiotherapy plays a key role in restoring movement and strength. Our therapists will guide you through gentle exercises to prevent stiffness and rebuild the muscles around the joint. This process takes time, and consistency is important for your recovery.

If pain persists, we may discuss medical management options. These can include pain relief medications or anti-inflammatory drugs to reduce swelling and discomfort. In some cases, we might consider injections, such as cortisone, to calm inflammation within the joint. These treatments aim to provide relief and improve function, allowing you to continue with your daily activities and rehabilitation. The duration of benefit varies from person to person.

Surgery is considered when conservative care has not provided sufficient improvement or when the fracture is too complex for non-surgical treatment. We use internal fixation, which involves realigning the bone fragments and holding them in place with plates and screws, to promote healing. For severe fractures that cannot be repaired, we may recommend joint replacement. This procedure removes the damaged parts of the joint and replaces them with artificial components to restore function and reduce pain.

What to expect

Your outlook depends largely on your age, bone health, and the specific pattern of your fracture. For most people, open reduction and internal fixation (ORIF) — where your surgeon realigns the bone fragments and secures them with plates and screws — leads to good functional outcomes. This is true for both younger adults and older patients. If your fracture is too complex to repair with plates, your surgeon may recommend a hemiarthroplasty (partial joint replacement) or, in select cases, a total elbow arthroplasty (full joint replacement). These options are designed to restore stability and allow you to use your arm again.

Recovery is a gradual process. The goal is to restore the natural alignment of your elbow so you can move it freely. Early motion is critical to prevent stiffness. While many patients regain a full range of motion, some may experience persistent stiffness or discomfort. Malunion, where the bone heals in an incorrect position, is a known risk. This can limit movement and cause long-term pain. Your surgeon will aim to avoid this by ensuring precise alignment during surgery.

It is important to be realistic about the challenges. In older adults, the risk of serious complications and even mortality within one to two years after this injury is substantial. This risk is closely linked to your overall health and how well you could walk before the injury. Smoking and poor bone quality, which can be identified through CT scans, also increase the risk of mechanical failure, such as screws loosening or plates breaking. If you have severe arthritis alongside your fracture, your surgeon might discuss total elbow replacement, though this carries a higher complication rate if done as a salvage procedure later on.

Without treatment, the elbow often becomes stiff, weak, and painful. You may lose the ability to lift objects or perform daily tasks. With careful management, most patients achieve satisfactory outcomes. However, outcomes can vary. Some people return to their previous level of activity, while others may have lasting limitations. Your surgeon will tailor the plan to your specific needs, balancing the desire for full function with the risks associated with your individual health profile.

When to see someone

See your GP if you have persistent pain that does not improve with rest. Ask for a specialist review if you notice weakness, instability, or if your elbow locks or gives way. Seek urgent care if symptoms interfere with your sleep or work, or if you experience a sudden worsening of pain. Older adults with these fractures face higher risks of complications and mortality, especially if you have other health conditions or struggled to walk before the injury. Early assessment helps your surgeon choose the best treatment to restore stability and function.

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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