Distal Humerus Fractures



BE is a 65-year-old woman who is brought to the Emergency Department complaining of severe arm pain after a fall from a standing height. On primary survey, she has a GCS of 15, a patent airway and is hemodynamically stable. On secondary survey, she has an obviously deformed right elbow. Her past medical history is unremarkable. She takes no medications and has no allergies.


Operative management of distal humerus fracture Nonoperative management of distal humerus fracture Supracondylar humerus fracture Ulnar nerve transposition Total elbow arthroplasty 


  1. 1.
    Srinivasan K, Agarwal M, Matthews SJ, Giannoudis PV. Fractures of the distal humerus in the elderly: is internal fixation the treatment of choice? Clin Orthop Relat Res. 2005(434):222–30.Google Scholar
  2. 2.
    Robinson CM, Hill RM, Jacobs N, Dall G, Court-Brown CM. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma. 2003;17(1):38–47.PubMedCrossRefGoogle Scholar
  3. 3.
    Brown RF, Morgan RG. Intercondylar T-shaped fractures of the humerus. Results in ten cases treated by early mobilisation. J Bone Joint Surg Br. 1971;53(3):425–8.PubMedGoogle Scholar
  4. 4.
    Schildhauer TA, Nork SE, Mills WJ, Henley MB. Extensor mechanism-sparing paratricipital posterior approach to the distal humerus. J Orthop Trauma. 2003;17(5):374–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Wilkinson JM, Stanley D. Posterior surgical approaches to the elbow: a comparative anatomic study. J Shoulder Elbow Surg. 2001;10(4):380–2.PubMedCrossRefGoogle Scholar
  6. 6.
    McKee MD, Kim J, Kebaish K, Stephen DJ, Kreder HJ, Schemitsch EH. Functional outcome after open supracondylar fractures of the humerus. The effect of the surgical approach. J Bone Joint Surg Br. 2000;82(5):646–51.PubMedCrossRefGoogle Scholar
  7. 7.
    Papaioannou N, Babis GC, Kalavritinos J, Pantazopoulos T. Operative treatment of type C intra-articular fractures of the distal humerus: the role of stability achieved at surgery on final outcome. Injury. 1995;26(3):169–73.PubMedCrossRefGoogle Scholar
  8. 8.
    Arnander MW, Reeves A, MacLeod IA, Pinto TM, Khaleel A. A biomechanical comparison of plate configuration in distal humerus fractures. J Orthop Trauma. 2008;22(5):332–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Zalavras CG, Vercillo MT, Jun BJ, Otarodifard K, Itamura JM, Lee TQ. Biomechanical evaluation of parallel versus orthogonal plate fixation of intra-articular distal humerus fractures. J Shoulder Elbow Surg. 2011;20(1):12–20.PubMedCrossRefGoogle Scholar
  10. 10.
    Shin SJ, Sohn HS, Do NH. A clinical comparison of two different double plating methods for intraarticular distal humerus fractures. J Shoulder Elbow Surg. 2010;19(1):2–9.PubMedCrossRefGoogle Scholar
  11. 11.
    McKee MD, Veillette CJ, Hall JA, Schemitsch EH, Wild LM, McCormack R, et al. A multicenter, prospective, randomized, controlled trial of open reduction – internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients. J Shoulder Elbow Surg. 2009;18(1):3–12.PubMedCrossRefGoogle Scholar
  12. 12.
    Frankle MA, Herscovici Jr D, DiPasquale TG, Vasey MB, Sanders RW. A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraarticular distal humerus fractures in women older than age 65. J Orthop Trauma. 2003;17(7):473–80.PubMedCrossRefGoogle Scholar
  13. 13.
    Jost B, Adams RA, Morrey BF. Management of acute distal humeral fractures in patients with rheumatoid arthritis. A case series. J Bone Joint Surg Am. 2008;90(10):2197–205.PubMedCrossRefGoogle Scholar
  14. 14.
    Prasad N, Dent C. Outcome of total elbow replacement for rheumatoid arthritis: single surgeon’s series with Souter-Strathclyde and Coonrad-Morrey prosthesis. J Shoulder Elbow Surg. 2010;19(3):376–83.PubMedCrossRefGoogle Scholar
  15. 15.
    Vazquez O, Rutgers M, Ring DC, Walsh M, Egol KA. Fate of the ulnar nerve after operative fixation of distal humerus fractures. J Orthop Trauma. 2010;24(7):395–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Ruan HJ, Liu JJ, Fan CY, Jiang J, Zeng BF. Incidence, management, and prognosis of early ulnar nerve dysfunction in type C fractures of distal humerus. J Trauma. 2009;67(6):1397–401.PubMedCrossRefGoogle Scholar
  17. 17.
    Chen RC, Harris DJ, Leduc S, Borrelli Jr JJ, Tornetta 3rd P, Ricci WM. Is ulnar nerve transposition beneficial during open reduction internal fixation of distal humerus fractures? J Orthop Trauma. 2010;24(7):391–4.PubMedCrossRefGoogle Scholar
  18. 18.
    Hamid N, Ashraf N, Bosse MJ, Connor PM, Kellam JF, Sims SH, et al. Radiation therapy for heterotopic ossification prophylaxis acutely after elbow trauma: a prospective randomized study. J Bone Joint Surg Am. 2010;92(11):2032–8.PubMedCrossRefGoogle Scholar
  19. 19.
    CIA World Factbook – country comparison: life expectancy at birth. https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html.
  20. 20.
    Doornberg JN, van Duijn PJ, Linzel D, Ring DC, Zurakowski D, Marti RK, et al. Surgical treatment of intra-articular fractures of the distal part of the humerus. Functional outcome after twelve to thirty years. J Bone Joint Surg Am. 2007;89(7):1524–32.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryBoston University Medical CenterBostonUSA
  2. 2.Department of Orthopedic SurgeryHarvard Medical School, Massachusetts General HospitalBostonUSA

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