Nonoperative treatment is not indicated for intraarticular fractures of the distal humerus, unless there is a general contraindication to surgery.
All adult articular fractures of the distal humerus require open anatomical reduction and stable fixation.
Because adult elbows are notorious for becoming stiff after injury, the goal of operative treatment is anatomical reduction and stable fixation, especially of any joint fragments, so that active motion can be started within a few days of surgery.
Pediatric fractures are considered in Pediatric trauma of Surgery Reference.
|ORIF - Plate and screw fixation|
|Most simple fractures through the trochlear groove|
For the majority of these fractures the treatment of choice is a plate, placed on the medial crest in a buttress mode, incorporating a lag screw across the condylar mass.
Contraindications for surgery
- Noncompliant patient
- Unacceptable surgical risk
- Extreme osteoporosis
Advantages of open reduction and internal fixation
- Anatomical reduction
- Articular congruity
- Early functional aftertreatment
- Reduced risk of degenerate joint disease
Disadvantages of open reduction and internal fixation
- Risk of infection
- Requirement for anesthesia
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|