Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA.
J Am Acad Orthop Surg. 2010 Jan;18(1):20-30. doi: 10.5435/00124635-201001000-00004.
Management of distal humerus fractures continues to challenge orthopaedic surgeons. The unique and complex anatomy of the distal humerus, involving the ulnohumeral and radiocapitellar joints, makes anatomic reduction difficult and hardware placement challenging. However, long-term results of well-performed open reduction and internal fixation demonstrate satisfactory outcomes in most patients. Osteoporosis in the elderly population often leads to severe comminution, which may render open reduction and internal fixation impossible. Total elbow arthroplasty in the elderly has become a viable option, with excellent results in the properly selected patient who understands the lifetime limitations of this option. Distal humeral replacement is a new and potentially exciting option but it is currently not approved by the US Food and Drug Administration and has no long-term follow-up to support its use.
肱骨远端骨折的治疗仍然是骨科医生面临的挑战。肱骨远端独特而复杂的解剖结构，涉及到肱尺和肱桡关节，使得解剖复位困难，内固定物的放置具有挑战性。然而，对于大多数患者来说，经过良好的切开复位和内固定术的长期效果是令人满意的。老年人的骨质疏松症常导致严重的粉碎性骨折，使切开复位和内固定术无法进行。老年人的全肘关节置换术已成为一种可行的选择，对于理解这种选择的终身局限性并选择合适的患者，可获得极佳的效果。肱骨远端置换是一种新的、令人兴奋的选择，但目前尚未获得美国食品和药物管理局的批准，也没有长期的随访结果来支持其使用。
