Distal Humerus Fractures Evolution of Management

Distal humerus fractures are a challenging problem that has vexed many orthopedic surgeons through the years. This article reviews the historical management of distal humerus fractures from nonoperative treatment to prolonged traction with ice tongs to the advent of AO technique and beyond. Current controversies, including plate orientation, ulnar nerve management, and the role of arthroplasty, are reviewed. Based on the best available evidence, parallel plating has been shown to be biomechanically superior, but no differences have been found in clinical outcomes, and the surgeon should let the fracture pattern dictate plate placement. The evidence surrounding ulnar nerve management is controversial, but a systematic review has shown no benefits to routine transposition. Finally, total elbow arthroplasty is an excellent option in geriatric fractures with osteoporotic bone and should be considered in these cases. Ultimately, distal humerus fractures, especially in the geriatric population, remain a difficult problem, but with meticulous technique and stable restitution of the bony columns and tie arch, good outcomes can be obtained.