Distal humerus fractures

Distal humerus fractures are challenging injuries to manage because of their complex nature, technical challenges, and difficult rehabilitation. Most distal humerus fractures require operative intervention. Proper treatment of these fractures depends on a thorough knowledge of the anatomy and biomechanics of the elbow, an adequate evaluation including imaging, expert surgical technique, and appropriate physical therapy. Many arguments still exist including the surgical approach, management of the ulnar nerve, fixation strategies, heterotopic ossification prophylaxis, and postoperative rehabilitation protocols. This chapter will begin by providing information regarding the anatomy and biomechanics of the elbow; the epidemiology of distal humerus fractures; and the proper evaluation of distal humerus fractures, including history-taking, neurovascular examination, radiographs, and the need for computed tomography. The body of the chapter will focus on the controversies surrounding the management of these fractures, how to appropriately identify which patients should be considered for open reduction and internal fixation or arthroplasty, and the risk factors identified for failure. Finally, we will discuss the complications associated with distal humerus fractures and how to avoid them.