肱骨远端骨折资料 In-depth

您的感受

肱骨远端骨折是上臂骨下端、肘关节上方发生的断裂。通常由手臂着地跌倒、直接撞击或伸直肘关节时承受突然的重负荷引起。许多人在受伤瞬间会感觉到或听到“啪”的一声。

疼痛通常立即出现且剧烈。肘部可能迅速肿胀，瘀斑往往在随后的一两天内显现。如果骨折碎片发生移位，关节外观可能变形。您可能不愿活动手臂，像转动门把手、提水壶或穿衣等简单任务会变得困难。肘部感觉不稳定，尝试使用它会加剧疼痛。

在最初几天和几周内，疼痛常在静息状态和夜间存在，任何试图活动肘部的动作都会使疼痛加剧。随着愈合开始，这种情况会逐渐缓解，尽管肘部可能会僵硬和压痛一段时间。肘部是一个复杂的关节，此处的骨折可能难以愈合，特别是当骨骼变薄或碎裂成多块时。一些人，特别是65岁以上的人，在恢复期间可能会出现并发症，因此您的医疗团队将密切关注手臂的恢复进展。

您的外科医生将与您讨论适合您骨折情况和健康状况的治疗方案。通常的方法是手术以重新对齐并固定骨折碎片，称为切开复位内固定术，即将碎片复位并用钢板和螺钉固定。对于某些老年人，特别是骨折无法重建的情况，可能会考虑全肘关节置换术。对于其他人，特别是健康状况不佳或对手臂功能要求较低的人，非手术治疗也可能效果良好。

实际发生了什么

您手臂骨骼的下端，即肱骨，在肘关节上方略微增宽，形成两根支撑性的骨柱。在这两根骨柱之间，有两个光滑、圆润的表面，它们构成了肘关节的活动部分。其中一个表面使您的肘部能够弯曲和伸直。另一个表面使您的前臂能够旋转，从而让手掌向上或向下翻转。

此处骨折就像木枝靠近主干连接处的分叉末端开裂一样。关节表面覆盖着一层光滑、润滑的软骨，而骨块之间由被称为韧带的强韧带状结构连接在一起。当骨骼断裂时，这些表面可能会分离和移位，导致关节不再平滑滑动。这就是为什么手臂感觉不稳定且无法承受重量的原因。

肘部还有狭窄的沟槽和间隙，活动部件会通过这些区域。如果骨折碎片移位到这些间隙中，或者愈合的骨骼或瘢痕组织填充了这些间隙，肘部可能会失去活动能力。有时，受伤的肘部在愈合过程中会在周围形成额外的骨骼，这可能会进一步限制弯曲和伸直。

骨骼通过重新连接来愈合，新的骨骼在数周至数月内跨越断裂处形成。为了有效愈合，骨块需要紧密贴合并保持静止。如果骨块已经移位分离，或者关节表面碎裂成多个碎片，它们不太可能自行对齐。手术会将碎片复位，并用钢板和螺钉固定，以便它们重新连接。当关节表面碎裂成过多的小碎片而无法重建时，置换肘关节可能是更好的选择。

您的外科医生将检查手臂和扫描图像，以确定有多少碎片、它们是否移位以及关节表面是否受到影响。这一情况将决定哪些治疗方案适合您。

我们如何处理

Mater Private Hospital Rockhampton 的上肢外科医生 Kieran Hirpara 医生会根据您的具体伤情匹配治疗方案。患者通常由全科医生（GP）转诊至我们的诊所；如果物理治疗师建议您就诊，您仍需获得全科医生的转诊，才有资格享受 Medicare（澳大利亚公共医疗保险）报销。在诊所，我们会检查您的手臂，审阅您的 X 光片，并在骨折情况复杂时安排 CT 扫描，以清晰查看骨折形态。随后，我们会与您详细讨论治疗选择。

对于某些骨折，非手术治疗效果良好。这适用于骨折碎片移位极小且肘关节仍保持稳定的情况，也适用于因健康状况或骨质条件使得手术不适合的老年人。治疗包括使用吊带、夹板或石膏固定手臂，以便骨骼愈合，期间通过复查 X 光片确认没有发生移位。一旦愈合允许，将通过物理治疗分阶段恢复活动。对于 65 岁以上的人群，这种治疗路径可以在避免严重僵硬或肘关节松动不稳定的情况下，维持其生活独立性。

当骨折累及关节、骨折碎片发生移位，或肘关节无法自行保持稳定时，建议从一开始就进行手术。当您需要手臂重新承受实际负荷时，手术也是通常的选择。手术目的是将骨折碎片复位至正常位置，并使用钢板和螺钉固定，以便骨骼以正确的形态愈合，并使肘关节能够早期开始活动。当关节面碎裂成过多的小碎片而无法重建时，置换部分或全部肘关节可能是更好的选择，特别是对于骨质较薄的老年人。修复与置换之间的选择是真正的共同决策，我们将与您讨论每种路径对您的手臂和生活意味着什么。

无论您选择哪种治疗路径，最初几周的重点是相同的。我们会控制疼痛，以便您能够休息和睡眠。在骨骼愈合期间，按照我们提供的计划保护手臂，明确其可以安全进行的活动范围。物理治疗会在合适的阶段开始——术后早期或在非手术治疗中愈合允许时——以重建屈曲、伸直和前臂旋转功能。我们会在整个过程中定期复诊，检查手臂的恢复情况。

预期情况

愈合过程需要数周至数月。新骨在骨折处形成，逐渐将碎片连接起来；在此期间，肘关节容易变得僵硬，因此一旦愈合允许，将通过物理治疗分阶段重建活动度。大多数人发现强烈的早期疼痛会在最初几周内消退，尽管肘部可能在一段时间内仍会感到压痛和紧绷。

如果您的骨折未接受手术治疗，手臂将保持静止直至骨骼愈合。对于65岁以上的人群，这种治疗方式可以维持其独立性，且不会出现严重的僵硬或肘关节松弛、不稳定。如果您接受手术，钢板和螺钉将在愈合期间固定碎片，且活动度可早期开始。从长期来看，部分接受过肘关节修复手术的人会在关节内发展为轻度至中度的退行性关节炎，这可能在多年后在X光片上显现。

每个人的恢复情况各不相同。穿衣、烹饪和提重物等日常活动通常会随着疼痛消退和活动度恢复而分阶段恢复。您何时能重返工作岗位或参与体育运动，取决于您的工作性质、骨折情况以及愈合进展，我们将在复查预约时与您讨论此事。

诚实地说，可能会出现并发症。大约三分之一的65岁以上患有此骨折的人在恢复期间会出现并发症。一种可能性是尺神经受到刺激或感觉异常，该神经经过肘部后方，可能导致小指和无名指出现麻木感；这种情况可能在手术后不久发生，也可能在较晚时出现。愈合中的肘关节周围有时会形成额外的骨组织，这可能限制其弯曲和伸直的范围。修复的碎片也可能移位或固定失败，特别是在骨骼较薄的情况下，吸烟会增加这种风险。当进行关节置换而非修复时，新关节通常长期功能良好，尽管有些人可能需要进一步的手术。您的医疗团队将在体检时监测这些问题，并就会出现的任何情况进行沟通。

何时就医

如果您的手臂外观变形、肘部有开放性伤口、手指出现麻木或刺痛感，或手臂完全无法活动，请立即寻求紧急医疗帮助。这些迹象需要立即评估。

如果疼痛未缓解，或者随着骨骼愈合，肿胀、活动度或日常功能未能逐周改善，请咨询您的全科医生或要求专科医生复诊。康复过程很少是线性的，但每周都应有一些变化。如果没有任何改善，值得让医生检查手臂，而不是被动等待。

深入探讨

Advanced reading: the deeper science (optional)

本节内容超出了您自身治疗决策所需的范围。肱骨远端骨折值得额外阅读，因为它位于一个棘手的交界部位：它是上肢中并发症发生率较高的骨折之一，标准手术入路涉及刻意折断第二根骨骼，且在老年患者中，是否进行手术的决定比您想象的更为复杂。

并发症发生率高于其声誉

针对经切开复位内固定治疗的关节内远端肱骨骨折，最大规模的汇总分析共纳入 2,362 例患者，其结论直截了当：并发症和再手术的发生率高于既往认知 [1]。

这是一个有益的纠正。这类骨折通常被描述为困难但可解决，且X线片上的技术效果往往极佳。在此处，良好的X线片与良好的肘关节功能之间的差距，比肢体其他几乎任何部位都要大，而既往文献对此存在低报现象。

显露本身有其代价

为了充分显露关节面，常规入路需通过截骨切断鹰嘴（即鹰嘴截骨术），并在手术结束时进行修复。这是解决显露困难这一实际问题的优雅方案，但并非毫无代价。

汇总 1,700 例截骨术，报告了 447 例并发症。伤口感染发生率为 4.2%，截骨愈合不良发生率为 3.7% [2]。因此，决定采用此显露方式，即意味着接受在术前完好无损的部位出现第二项问题的微小但确定的风险。作者的表述是正确的：风险必须是进行截骨术决策的一部分，而非附注。

就其价值而言，后路显露方式之间的选择似乎不如是否采用后路显露这一决定重要。一项针对 1,258 例完全关节内骨折（AO/OTA C 型）患者的荟萃分析，比较了鹰嘴截骨术与肱三头肌翻转、肱三头肌劈开及肱三头肌保留入路，发现总体结局相当，大多数指标无统计学显著差异 [3]。

在老年患者中，该问题确实尚无定论

人们普遍有一种强烈的直觉，认为移位的关节内骨折必须予以固定。在老年成年人中，这种直觉并未得到比较数据的充分支持。

一项针对 1,838 名老年患者的系统综述比较了手术与非手术治疗，发现所研究的每种治疗方式均能产生合理的肘关节功能水平 [4]。作者谨慎地指出，这并非停止手术的建议：纳入的研究大多为非比较性研究，且存在相当大的偏倚风险。这属于缺乏优越性证据，而非等效性证据。

尽管如此，其实际意义依然成立。对于功能需求较低的衰弱患者，以舒适和早期活动为核心、而非以解剖重建为核心的治疗计划，是一个可辩护的选择，其结局并不明显更差，并且避免了上述所有并发症。

这对您意味着什么

由此可得出三点结论。请预期康复过程主要关乎活动度，而非骨骼愈合，骨骼愈合是较容易的部分。请具体询问计划采用的手术入路及其对您后续的要求。如果您年龄较大，或对上肢的功能需求有限，请直接询问非手术治疗在您的情况下是否合理，因为诚实的回答可能是肯定的。

参考文献

[1] Yetter TR, Weatherby PJ, Somerson JS. 关节内肱骨远端骨折内固定术的并发症：系统综述与荟萃分析。J Shoulder Elbow Surg. 2021;30(8):1957-67. https://doi.org/10.1016/j.jse.2021.02.017

[2] Spierings KE, Schoolmeesters BJ, Doornberg JN, Eygendaal D, van den Bekerom MP. 肱骨远端骨折治疗中鹰嘴截骨术的并发症。Clin Shoulder Elb. 2022;25(2):163-9. https://doi.org/10.5397/cise.2021.00591

[3] Yao H, Chen W, Lin Z, Cao H. 不同后路手术入路治疗关节内肱骨远端骨折的比较疗效与安全性。J Orthop Surg Res. 2026;21(1). https://doi.org/10.1186/s13018-026-06739-x

[4] Stoddart MT, Panagopoulos GN, Craig RS, Falworth M, Butt D, Rudge W, et al. 老年人肱骨远端骨折治疗的系统综述：手术与非手术方案的比较。Shoulder Elbow. 2022;16(2):175-85. https://doi.org/10.1177/17585732221099845

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].
Internal fixation is generally accepted as the standard of care for the treatment of intra-articular distal humerus fractures [4].
Rigid anatomic fixation combined with early motion is associated with favorable results for intra-articular distal humerus fractures [4].
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 [10].
Older patients who underwent ORIF of the distal humerus using a parallel construct demonstrated good functional outcomes [1].
Older patients who underwent ORIF of the distal humerus using a parallel construct demonstrated 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 [14].
For comminuted distal humerus fractures in young patients, ORIF offers superior functional outcomes compared to hemiarthroplasty [14].
For comminuted distal humerus fractures in young patients, ORIF offers a lower incidence of complications and heterotopic ossification compared to hemiarthroplasty [14].
Distal humerus hemiarthroplasty is a viable option in the treatment of unreconstructible distal humerus fractures [2].
Distal humerus hemiarthroplasty is expected to yield good to excellent outcomes for unreconstructible distal humerus fractures [2].
Distal humeral hemiarthroplasty is a suitable option for unreconstructable distal humeral fractures [11].
Distal humeral hemiarthroplasty offers good functional outcomes for unreconstructable distal humeral fractures [11].
Distal humeral hemiarthroplasty offers acceptable complication rates for unreconstructable distal humeral fractures [11].
Elbow hemiarthroplasty is a viable option for complex distal humeral fractures in select patients [16].
Elbow hemiarthroplasty offers functional outcomes comparable to total elbow arthroplasty for complex distal humeral fractures [16].
Elbow hemiarthroplasty potentially avoids complications related to the ulnar component compared to total elbow arthroplasty [16].
Total elbow arthroplasty provides a successful treatment alternative for selected distal humerus fractures [32].
Total elbow arthroplasty is particularly indicated for distal humerus fractures in elderly patients with low anticipated physical demands, severe osteopenia, or comminution [32].
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].
A 2021 systematic review represents the largest report of complications and reoperations of intra-articular distal humeral fractures after ORIF in the current literature [8].

Anatomy & Pathophysiology

Bony Anatomy

The elbow is a trocho-ginglymoid joint consisting of medial and lateral articulations that provide bony stability [37].
The medial side features the trochlea articulating with the ulna within the greater sigmoid notch to form the ulnohumeral, hinged, or trochoid portion of the joint [37].
The ulnohumeral articulation exhibits highly congruent anatomy through almost 180° of articular contact, excluding the bare area of the greater sigmoid notch which lacks cartilage [37].
The coronoid process possesses medial and lateral facets that buttress the trochlea anteriorly [37].
The sublime tubercle is located just distal and medial to the coronoid and serves as the attachment site for the anterior bundle of the medial ulnar collateral ligament [37].
The medial epicondyle is larger and more posteriorly oriented than the lateral epicondyle and serves as the attachment site for the origins of the flexor pronator mass [37].
Laterally, the capitellum and radial head form the radiocapitellar joint [37].
The radial head is a concave elliptical structure covered with articular cartilage along the radiocapitellar joint and approximately 270° of the articular margin [37].
The radial head articulates with both the capitellum and the lesser sigmoid notch of the ulna [37].
The radius is held in close approximation to the ulna at the proximal radioulnar joint by the annular ligament [37].
The distal humeral articulation is angled 30° from the longitudinal axis of the humerus [37].
The anterior humeral line should pass through the center of the axis of rotation to avoid loss of flexion or extension during reconstructive efforts [37].
The axis of rotation is angulated 5° to 7° in the coronal plane relative to the epicondylar axis, with the medial side positioned more distal than the lateral side [37].
This coronal angulation accounts for the change from a valgus carrying angle to a more varus position as the elbow flexes [37].
The ulna medially bends approximately 8° at 8 cm from the tip of the olecranon [37].
The articulation to the tip of the coronoid is approximately 30° from the long axis of the ulna in the sagittal plane [37].
The central area of the distal humerus comprises a coronoid fossa and an olecranon fossa, which is thin to allow extensive range of motion but acts as a weak point for complex fractures [9].
The medial column holds the medial epicondyle and medial portion of the humeral trochlea and appears continuous with the humeral shaft axis when viewed from the side [9].
The lateral column is flexed relative to the humeral shaft, placing the capitellum ahead of the trochlea [9].
The epiphyseal section of the distal humerus containing the trochlear and capitellum articular surfaces is in 4–8° valgus relative to the shaft [9].
The epiphyseal section of the distal humerus is externally rotated by 3–8° relative to the metaphysis [9].
The epiphyseal section of the distal humerus is flexed 40° relative to the shaft [9].
The radial head should line up with the capitellum at all arm positions on all radiographic views [38, 39].
Tensile forces are present at the medial elbow, while compressive forces are present at the lateral elbow [38, 39].

Ligaments and Soft Tissue

Elbow stability is conferred by bony articular anatomy and ligamentous structures on the medial and lateral sides [25].
The primary stabilizers of the elbow are the ulnohumeral articulation, the medial ulnar collateral ligament (MUCL), and the lateral ulnar collateral ligament (LUCL) complex [25].
The secondary stabilizers of the elbow are the radiocapitellar articulation, the common flexor tendon, the common extensor tendon, and the joint capsule [25].
The medial ulnar collateral ligament is the primary valgus stabilizer of the elbow [38, 39].
The anterior bundle of the medial ulnar collateral ligament is the most important component for stability [38, 39].
The posterior bundle of the medial ulnar collateral ligament undergoes the greatest change in length and becomes taut at flexion beyond 120 degrees [38, 39].
The lateral ulnar collateral ligament acts as the posterolateral stabilizer of the elbow [38, 39].
Osborne’s ligament stabilizes the ulnar nerve in the cubital tunnel [38, 39].
The ligament of Struthers is a variant anatomy arising from the supracondylar process to attach to the medial epicondyle and is a potential site of median nerve compression [38, 39].
The joint capsule allows maximum distension at approximately 70 to 80 degrees of flexion [38, 39].
The anterior capsule attaches at a point approximately 6 mm distal to the tip of the coronoid [38, 39].
The coronoid tip is an intraarticular structure that is visualized during elbow arthroscopy [38, 39].

Muscles

The brachialis is the strongest elbow flexor and attaches to the coronoid 11 mm distal to the tip [38, 39].
The biceps brachii inserts at the ulnar margin of the radial tuberosity and acts as a powerful supinator of the forearm [38, 39].
The triceps is the primary elbow extensor and inserts on the olecranon process [38, 39].
The mobile wad consists of the brachioradialis, extensor carpi radialis longus, and extensor carpi radialis brevis [38, 39].
The flexor-pronator mass consists of the pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, and flexor digitorum superficialis [38, 39].

Pathophysiology and Biomechanics

The normal elbow has a range of motion from 0° to 140° from extension to flexion [25].
The normal elbow has a range of motion of 75° in pronation and 85° in supination [25].
A functional arc for the elbow is 100° for flexion and extension and forearm rotation [25].
Injury to primary or secondary stabilizers causes elbow instability [25].
Malunion is a common complication after distal humerus fractures influenced by biology, reduction, fixation methods, and mechanical failure [6].
Normal function of the distal humerus is difficult to restore if the joint is deformed by malunion or stiffened by heterotopic ossifications or capsular and ligament contractures [9].
Coronal shear fractures of the distal humerus can involve the capitellum, the trochlea, or both [56].
Capitellum fractures account for 1% of all elbow fractures and 6% of distal humeral fractures [56].
A potential mechanism for coronal shear fracture involves a direct axial load transmitted to the capitellum by the radial head following a fall onto an outstretched hand [56].
A second mechanism for coronal shear fracture involves lateral collateral ligament complex failure, posterolateral subluxation, and shearing of the capitellum and trochlea by the radial head and coronoid during forearm reduction [56].
Posterior shear fractures of the distal humerus mostly involve the posterior aspect of the capitellum and are often associated with elbow dislocation [50].
The inherent complexity of the distal humerus makes a single treatment method unrealistic [24].

Classification

The AO/OTA classification scheme for distal humerus fractures categorizes type A fractures as extraarticular metaphyseal, transcondylar, and apophyseal [19].
The AO/OTA classification scheme for distal humerus fractures categorizes type B fractures as partial articular [19].
The AO/OTA classification scheme for distal humerus fractures categorizes type C fractures as complete articular [19].
Distal humerus fractures are classified using the AO/OTA classification system [20].
The Dubberley classification is utilized for describing coronal shear fractures of the distal humerus and selecting the surgical approach [52].
Outcomes for capitellum fractures are unclear due to the use of multiple classification systems [55].

Clinical Presentation

Fractures of the distal humerus account for approximately 0.5% of all fractures in adults [20].
The incidence of distal humerus fractures is approximately 5.8/100,000 people reported over 1 year in a high volume trauma centre [20].
The distribution of distal humerus fractures by age is unimodal with a low risk in young adults that increases from the age of 50 years and rises markedly in those over 80 years [20].
There is a higher incidence of distal humerus fractures in the female population [20].
Distal humerus fractures are osteoporotic fractures [20].
The number of distal humerus fracture cases is thought to be increasing in developed nations due to the ageing population [20].
The age-adjusted incidence of distal humerus fractures may be consistent or falling slowly [20].
Approximately 3000 distal humerus fractures in adults and children are treated surgically every year in France [9].
An orthopaedic surgeon in France sees an average of five distal humerus fractures per year [9].
In older adults with isolated distal humerus fractures, mortality at 1 and 2 years is substantial [17].
In older adults with isolated distal humerus fractures, mortality is strongly predicted by comorbidity burden and preinjury ambulation [17].

Investigations

Imaging Modalities

Plain radiographs remain the hallmark and best screening test for elbow evaluation [25].
Standard radiographic views include AP, lateral, and oblique projections [43].
Computed tomography (CT) is helpful for assessing malunion architecture and the location and pattern of osteophytes or loose bodies [43].
Three-dimensional CT is used to check for heterotopic ossification [43].
CT is not necessary when elbow stiffness is entirely soft-tissue related [43].
CT is beneficial if any joint incongruity or abnormal bony anatomy is present [43].
Magnetic resonance imaging (MRI) can be used to evaluate ligaments and tendons but is rarely indicated for elbow stiffness [43].
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 [23].

Physical Examination

The physical examination of the elbow is directed by history and the location of the patient's pain in the anterior, posterior, medial, or lateral aspect [25].
Stability of the elbow is conferred by bony articular anatomy and ligamentous structures on the medial and lateral sides, which should be the focus of physical examination [25].
The normal elbow has a range of motion of 75° and 85° in pronation and supination, respectively [25].
Elbow stability is determined by primary stabilizers (ulnohumeral articulation, MUCL, LUCL complex) and secondary stabilizers (radiocapitellar articulation, common flexor tendon, common extensor tendon, joint capsule) [25].
Active and passive flexion, extension, supination, and pronation should be evaluated using a goniometer for accurate measurement [43].
If the elbow has less than 90° to 100° of flexion, the posterior bundle of the medial collateral ligament is contracted and must be released to restore flexion [43].
Pain during the mid-arc of range of motion is more common with intrinsic disease and may not improve with contracture release alone [43].
The ulnar nerve is of utmost importance in the physical examination due to its anatomic proximity to the elbow [43].
Electromyography and nerve conduction velocity studies should be performed if there is any question about neurologic dysfunction [43].
An assessment for ulnar nerve subluxation should be performed, as subluxation is a relative contraindication for an arthroscopic procedure [43].

Diagnostic Considerations

Reported outcomes for acute distal humerus fractures remain inconsistent across the orthopedic literature, making it difficult to retrospectively compare surgical techniques and clinical outcomes [3].
The treatment process for articular distal humerus fractures consists of determining the injury mechanism, defining diagnostic modalities, and developing a treatment algorithm [9].

Treatment

General Principles and Decision Making

The management of distal humeral fractures remains problematic, particularly in elderly patients with osteoporosis and comminution where ORIF may be impossible [21].
Non-operative treatment is generally reserved for completely undisplaced stable fractures or for patients in whom the risks of surgery outweigh the benefits [20].

Open Reduction and Internal Fixation (ORIF)

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].
Both orthogonal and parallel plating techniques can be used to treat distal humerus fractures with excellent outcomes [15].
Dual plating provides the most rigid and reliable construct for reduction of the articular surface to allow for early range of motion and physical rehabilitation [24].
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 [22].

Arthroplasty

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 [11].
DHH yields satisfactory functional outcomes and range of motion in complex distal humerus fractures not amenable to fixation, particularly in elderly patients [13].
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 [32].
Total elbow arthroplasty can be considered for the treatment of acute distal humeral fractures when osteosynthesis is not feasible, particularly in physiologically older patients with lower demands on the joint [33].
The indications for semiconstrained total joint replacement for acute fractures of the distal humerus are limited to a restricted group of patients older than 60-65 years with an extensively comminuted fracture that is not amenable to adequate and stable osteosynthesis [27].
Salvage TEA represents a viable option for the management of post-traumatic sequelae following the treatment of a distal humeral fracture [12].
Patients who underwent salvage TEA had a significantly increased rate of complications and significantly inferior functional outcomes compared with those who underwent TEA acutely [12].

Complications

Mechanical and Bony Complications

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 [23].

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 [59].
Elbow hemiarthroplasty potentially avoids complications related to the ulnar component [16].

Patients who underwent salvage total elbow arthroplasty had a significantly increased rate of complications compared with those who underwent total elbow arthroplasty acutely [12].
Distal humeral hemiarthroplasty offers acceptable complication rates [11].

Mortality

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].

Recovery

Functional Outcomes and Salvage Procedures

Older patients who underwent open reduction and internal fixation (ORIF) of the distal humerus using a parallel construct demonstrated good functional outcomes [1].
Good to excellent outcomes are expected for distal humerus hemiarthroplasty in the treatment of unreconstructible distal humerus fractures [2].
Distal humeral hemiarthroplasty offers good functional outcomes with acceptable complication rates for unreconstructable distal humeral fractures [11].
Distal humerus hemiarthroplasty yields satisfactory functional outcomes and range of motion in complex distal humerus fractures not amenable to fixation [13].
Distal humerus hemiarthroplasty yields satisfactory functional outcomes and range of motion in complex distal humerus fractures not amenable to fixation, particularly in elderly patients [13].
Elbow hemiarthroplasty offers functional outcomes comparable to total elbow arthroplasty for complex distal humeral fractures in select patients [16].
Salvage total elbow arthroplasty (TEA) represents a viable option for the management of post-traumatic sequelae following the treatment of a distal humeral fracture [12].
Patients who underwent salvage TEA had a significantly increased rate of complications compared with those who underwent TEA acutely [12].
Patients who underwent salvage TEA had significantly inferior functional outcomes compared with those who underwent TEA acutely [12].
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 [61].
Nearly 5.5% of patients with intra-articular fractures progressed to TEA by 10 years [61].

Complications and Mortality

Malunion is a common complication after distal humerus fractures [6].
Malunion after distal humerus fractures is influenced by biology, reduction, fixation methods, and mechanical failure [6].
In older adults with isolated distal humerus fractures, mortality at 1 and 2 years is strongly predicted by comorbidity burden and preinjury ambulation [17].
Transposition does not have a protective effect against the development of late ulnar neuropathy after distal humerus fracture repair surgery [62].

Measurement and Risk Factors

Reported outcomes for acute distal humerus fractures remain inconsistent across the orthopedic literature [3].
The inconsistency in reported outcomes for acute distal humerus fractures makes it difficult for surgeons to retrospectively compare surgical techniques and clinical outcomes across studies [3].

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] 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. [4] (10.1016/j.hcl.2007.09.001)
[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)
[L1] This systematic review is the largest report of complications and reoperations of intra-articular distal humeral fractures after ORIF in the current literature. [8] (10.1016/j.jse.2021.02.017)
[L4] [9] (10.1016/j.otsr.2013.11.002)
[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. [10] (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. [11] (10.1177/17585732211023100)
[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. [12] (10.1302/0301-620x.108b1.bjj-2025-0475.r1)
[L1] DHH yields satisfactory functional outcomes and range of motion in complex distal humerus fractures not amenable to fixation, particularly in elderly patients. [13] (10.1016/j.jseint.2026.101695)
[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. [14] (10.1016/j.xrrt.2025.07.014)
[L5] Distal humerus fractures are complex, and both orthogonal and parallel plating techniques can be used to treat these difficult fractures with excellent outcomes. [15] (10.1016/j.hcl.2010.05.008)
[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. [16] (10.1177/1758573216640210)
[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] [19] (10.5435/00124635-201001000-00004)
[L1] [20] (10.1177/17585732251328594)
[L5] The management of distal humeral fractures remains problematic, particularly in elderly patients with osteoporosis and comminution where ORIF may be impossible. [21] (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. [22] (10.1186/s13018-026-06739-x)
[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. [23] (10.5435/jaaos-d-26-00191)
[L4] Although the inherent complexity of the distal humerus makes a single treatment method unrealistic, dual plating provides the most rigid and reliable construct for reduction of the articular surface to allow for early range of motion and physical rehabilitation. [24] (10.1016/j.jse.2025.12.020)
[L5] [27] (10.1097/01.blo.0000131485.47685.8c)
[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. [32] (10.1016/j.hcl.2015.06.008)
[L4] Total elbow arthroplasty can be considered for the treatment of acute distal humeral fractures when osteosynthesis is not feasible, particularly in physiologically older patients with lower demands on the joint. [33] (10.2106/jbjs.d.02871)
[L4] Posterior shear fractures of the distal humerus mostly involve the posterior of the capitellum and are often associated with elbow dislocation. [50] (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. [52] (10.1016/j.jse.2025.05.033)
[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. [55] (10.1177/1558944719878817)
[L4] [56] (10.1016/j.hcl.2004.08.001)
[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. [59] (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. [61] (10.1177/17585732261451863)
[L1] The authors conclude that transposition does not have a protective effect against the development of late ulnar neuropathy after distal humerus fracture repair surgery. [62] (10.1016/j.hcl.2017.09.010)

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