Background and challenges
Distal humeral fractures are demanding for the surgeon because of the complex joint anatomy and the small fragments. In addition, the elbow joint tends to develop postoperative stiffness which may result in a severe handicap.
Therapy
Regarding operative treatment, anatomical angular stable plates are currently preferred. Each column is stabilized with a separate plate, the latter may by positioned orthogonal or parallel. The standard approach is still the paratriceps approach with osteotomy of the olecranon. The triceps-reflecting approach is a muscle-sparing approach that is useful for the implantation of endoprostheses. The introduction of angular stable plates reduced the necessity for primary bone transplantation. The transposition of the ulnar nerve may be considered, if the nerve is in contact with the implant. Joint replacement is mainly indicated in elderly, osteoporotic patients with small distal fragments. Although evidence is limited, ossification prophylaxis against the development of periarticular ossification with radiotherapy or non-steroidal anti-inflammatory drugs is recommended in high-risk patients (e.g., severe head trauma, repetitive elbow dislocation, late operation).