This 2011 JBJS current concepts review by Nauth et al. synthesizes the evidence on managing distal humeral fractures in adults, covering classification, operative approach selection, dual plate fixation strategies, coronal shear fractures, total elbow arthroplasty, ulnar nerve management, and heterotopic ossification prophylaxis — with explicit graded recommendations for each decision point.
When managing a distal humeral fracture in a patient over 65 with comminuted intra-articular involvement, plan for possible acute TEA from the outset — avoid olecranon osteotomy as your approach (it compromises olecranon component fixation) and consent the patient accordingly, since 1 in 4 ORIF attempts in this population will prove unreconstructable intraoperatively.
For bicondylar fractures in younger patients, apply strong dual plates (≥3.5 mm; no one-third tubular plates) and initiate range-of-motion within 14 days — rigidity of fixation and early mobilization are the primary determinants of functional outcome.
This 2011 JBJS current concepts review by Nauth et al. synthesizes the evidence on managing distal humeral fractures in adults, covering classification, operative approach selection, dual plate fixation strategies, coronal shear fractures, total elbow arthroplasty, ulnar nerve management, and heterotopic ossification prophylaxis — with explicit graded recommendations for each decision point.
When managing a distal humeral fracture in a patient over 65 with comminuted intra-articular involvement, plan for possible acute TEA from the outset — avoid olecranon osteotomy as your approach (it compromises olecranon component fixation) and consent the patient accordingly, since 1 in 4 ORIF attempts in this population will prove unreconstructable intraoperatively.
For bicondylar fractures in younger patients, apply strong dual plates (≥3.5 mm; no one-third tubular plates) and initiate range-of-motion within 14 days — rigidity of fixation and early mobilization are the primary determinants of functional outcome.