Open Reduction and Internal Fixation for Distal Humerus Fractures and Nonunions

Abstract

Open reduction and internal fixation is the treatment of choice for most adult patients with fractures of the distal humerus. Articular fractures of the distal humerus involving only the capitellum have uniformly good outcomes when properly fixed. More complex shear fractures of the articular surface of the humerus and fractures extending into the columns require meticulous attention to exposure and fixation techniques; parallel plating using precontoured periarticular plates is most reliable for the whole spectrum of fracture patterns. Distal humerus nonunions may also be treated with internal fixation; protection of the ulnar nerve, adequate debridement of the nonunion site, selective shortening to ensure good contact and compression, release of associated contractures, and liberal use of bone graft are paramount for success. As mentioned in other chapters, elbow arthroplasty is better suited for selected distal humerus fractures and the salvage of some nonunions.