Abstract
As our population ages fractures of the distal humerus will become increasingly common, with a nearly threefold increase projected by the year 2030 [1]. The major determinant in this expected rise in fracture rates is a corresponding increase in the number of patients with osteoporosis. The treatment of the osteoporotic distal humerus fracture has traditionally posed great difficulty and surgical results have often been disappointing [2–6]. However, with the advent of newer fixation techniques and evolving treatment modalities, the initial despair with which these injuries were viewed has given way to a more optimistic outlook. Significant osteoporosis is no longer considered a contraindication to aggressive surgical stabilization and good results can be obtained even in the severely osteopenic patient [7–14]. The liberal use of bone graft, multiple plate and screw fixation techniques, and the use of methylmethacrylate for enhanced screw fixation have all been important developments in the treatment of these fractures. Furthermore, total elbow arthroplasty provides us with a salvage procedure for those rare injuries that are not amenable to operative reconstruction. It is imperative that the treating physician has a thorough understanding of modern surgical principles and techniques in order to treat fractures of the osteoporotic distal humerus effectively.
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References
Palvanen M, Kannus P, Niemi S, Parkkari J. Secular trends in the osteoporotic fractures of the distal humerus in elderly women. Eur J Epidemiol 1998;14:159–164.
Brown RF, Morgan RG. Intercondylar T-shaped fractures of the humerus. Results in ten cases treated by early mobilisation. J Bone and Joint Surg Br 1971;53:425–428.
Evans EM. Supracondylar Y fractures of the humerus. J Bone Joint Surg Br 1953; 35:381–385.
Keon-Cohen BT. Fractures at the elbow. J Bone Joint Surgery Am 1966;48:1623–1639.
Miller WE. Comminuted fractures of the distal end of the humerus. J Bone Joint Surg Am 1964;46:644–656.
Riseborough EJ, Radin EL. Intercondylar T fractures of the humerus in the adult. A comparison of operative and nonoperative treatment in twenty-nine cases. J Bone Joint Surg Am 1969;51:130–141.
Jupiter JB, Neff U, Holzach P, Allgower M. Intercondylar fractures of the humerus. An operative approach. J Bone Joint Surg Am 1985;67:226–239.
Gabel GT, Hanson G, Bennett JB, Noble PC, Tullos HS. Intra-articular fractures of the distal humerus in the adult. Clin Orthop 1987;216:99–108.
Aitken GK, Rorabeck CH. Distal humeral fractures in the adult. Clin Orthop 1986;207:191–197.
Holdsworth BJ, Mossad MM. Fractures of the adult distal humerus. Elbow function after internal fixation. J Bone Joint Surg Br 1990;72:362–365.
Jupiter JB. Complex fractures of the distal part of the humerus and associated complications. Instr Course Lect 1995;44:187–198.
Kundel K, Braun W, Wieberneit J, Ruter A. Intra-articular distal humerus fractures. Factors affecting functional outcome. Clin Orthop 1996;332:200–208.
Zagorski JB, Jennings JJ, Burkhalter WE, Uribe JW. Comminuted intra-articular fractures of the distal humeral condyles. Surgical vs nonsurgical treatment. Clin Orthop 1986;202:197–204.
Hubert J, Rosso R, Neff U, Bodoky A, Regazzoni P, Harder F. Operative treatment of distal humeral fractures in the elderly. J Bone Joint Surg Br 1994;76:793–796.
Hastings H, II, Engles DR. Fixation of complex elbow fractures, Part I. General overview and distal humerus fractures. Hand Clin 1997;13:703–719.
Morrey BF. Post-traumatic stiffness: distraction arthroplasty. In: Morrey BF, editor. The elbow and its disorders, 2nd ed. Philadelphia: Saunders, 1993:476–491.
Atkinson WB, Elftman H. The carrying angle of the human arm as a secondary symptom character. Anat Rec 1945;91:49.
Keats TE, Teeslink R, Diamond AE, et al. Normal axial relationships of the major joints. Radiology 1966;87:904.
Beals RK. The normal carrying angle of the elbow: a radiographic study of 422 patients. Clin Orthop 1976; 119:194.
Halls AA, Travill A. Transmission of pressures across the elbow joint. Anat Rec 1964;150:243.
Morrey BF. Anatomy of the elbow joint. In: Morrey BF, editor. The elbow and its disorders, 2nd ed. Philadelphia: Saunders, 1993:16.
McKee MD, Mehne DK, Jupiter JB. Trauma to the adult elbow and fractures of the distal humerus. II. Fractures of the distal humerus. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, editors. Skeletal Trauma. 2nd ed. Philadelphia: Saunders, 1998:1488.
Milch H. Fractures and fracture-dislocations of the humeral condyles. J Trauma 1964;4:592–607.
Kuhn JE, Louis DS, Loder RT. Divergent single-column fractures of the distal part of the humerus. J Bone Joint Surg Am 1995;77:538–542.
Jupiter JB, Barnes KA, Goodman LJ, Saldana AE. Multiplane fracture of the distal humerus. J Orthop Trauma 1993;7:216–220.
Bryan RS, Morrey BF. Fractures of the distal humerus. In: Morrey BF, editor. The elbow and its disorders. Philadelphia: Saunders, 1985:302–339.
McKee MD, Jupiter JB, Bamberger HB. Coronal shear fractures of the distal end of the humerus [see comments]. J Bone Joint Surg Am 1996;78:49–54.
Muller ME, Nazarian S, Koch P. AO Classification of fractures. Berlin Heidelberg New York: Springer, 1987.
Greenspan A, Norman A. Radial head-capitellum view: an expanded imaging approach to elbow injury. Radiology 1987; 164:272.
Greenspan A, Norman A, Rosen H. Radial head-capitellum view in elbow trauma: clinical application and radiographic-anatomic correlation. AJR 1984; 143:355.
Greenspan A. The radial head-capitellum view: another example of its usefulness [letter]. AJR 1982;139:193.
Head RW. Radial head-capitellum view in elbow trauma. AJR 1983;140:1273.
Sultanpur A. Anterior supracondylar fracture of the humerus (flexion type): a simple technique for closed reduction and fixation in adults and the aged. J Bone Joint Surg Br 1978;60:383–386.
Hotchkiss RN. Fractures and dislocations of the elbow. In: Rockwood CA Jr, Green DP, Bucholz RW, Heckman JD, editors. Fracturs in adults, 4th ed. Philadelphia: Lippincott-Raven, 1996:937–939.
Bohler L. The treatment of fractures. Philadelphia: Grune & Stratton, 1956.
Smith FM. Surgery of the elbow, 2nd ed. Philadelphia: Saunders, 1972.
Conn J, Wade PA. Injuries of the elbow (a ten-year review). J. Trauma 1961;1:248–268.
Eastwood WJ. The T-shaped fracture of the lower end of the humerus. J Bone Joint Surg 1937;19:364–369.
Bryan RS, Morrey BF. Extensile posterior exposure of the elbow: a triceps-sparing approach. Clin Orthop 1982; 166:188.
Morrey BF. Surgical exposures of the elbow. In: Morrey BF, editor. The elbow and its disorders, 2nd ed. Philadelphia: Saunders, 1993:139–167.
Weber B, Vasey H. Osteosynthese bei Olecranon Fraktur. A Unfallmed Berufskr 1963;2:90.
Helfet DL, Hotchkiss RN. Internal fixation of the distal humerus: a biomechanical comparison of methods. J Orthop Trauma 1990;4:260–264.
Waddell JP, Hatch J, Richards R. Supracondylar fractures of the humerus: results of surgical treatment. J Trauma 1988;28:1615–1621.
Jupiter JB, Morrey BF. Fractures of the distal humerus in the adult. In: Morrey BF, editor. The elbow and its disorders, 2nd ed. Philadelphia: Saunders, 1993:328–366.
Cobb TK, Morrey BF. Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients. J Bone Joint Surg Am 1997;79:826–832.
Morrey BF, Adams RA. Semiconstrained elbow replacement for distal humeral nonunion [see comments]. J Bone Joint Surg Br 1995;77:67–72.
Conney WP. Contractures of the elbow. In: Morrey BF, editor. The elbow and its disorders, 2nd ed. Philadelphia: Saunders, 1993:466.
Morrey BF. Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty. J Bone Joint Surg 1990;61:601.
Sim FH, Morrey BF. Nonunion and delayed union of distal humeral fractures. In: Morrey BF, editor. The elbow and its disorders, 2nd ed. Philadelphia: Saunders, 1993:367–382.
Ackerman G, Jupiter JB. Non-union of fractures of the distal end of the humerus. J Bone Joint Surg 1988;70:75–83.
Figgie MP, Inglis AE, Mow CS, Figgie HE. Salvage of non-union of supracondylar fracture of the humerus by total elbow arthroplasty. J Bone Joint Surg 1989;71:1058–1065.
Mitsunaga MM, Bryan RS, Linscheid RL. Condylar nonunions of the elbow. J Trauma 1982;22:787–791.
Jupiter JB, Goodman LF. The management of complex distal humerus nonunions in the elderly by elbow capsulotomy, triple plating, and ulnar nerve neurolysis. J Shoulder Elbow 1992;1:37–46.
McKee M, Jupiter J, Toh CL, Wilson L, Colton C, Karras KK. Reconstruction after malunion and nonunion of intra-articular fractures of the distal humerus. Methods and results in 13 adults. J Bone Joint Surg Br 1994;76:614–621.
Morrey BF, Adams RA. Total replacement for post-traumatic arthritis of the elbow. J Bone Joint Surg Br 1991;73:607.
Cobb TK, Linscheid RL. Late correction of malunited intercondylar humeral fractures. J Bone Joint Surg Br 1994;76:622.
Lecestre R. Round table on fractures of the lower end of the humerus. Societe Francaise de Chirurgie Orthopedique et Traumatolgie. Orthop Trans 1980;4:123.
Groh GI, Bennett JB. Fractures of the elbow region. In: Peimer CA, editor. Surgery of the hand and upper extremity. New York: McGraw-Hill, 1996:425–448.
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Hastings, H., Robichaux, M.R. (2000). Fractures of the Distal Humerus. In: Obrant, K. (eds) Management of Fractures in Severely Osteoporotic Bone. Springer, London. https://doi.org/10.1007/978-1-4471-3825-9_18
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DOI: https://doi.org/10.1007/978-1-4471-3825-9_18
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