Distal humeral fractures: role of internal fixation and elbow arthroplasty.

Fractures of the distal humerus can be challenging to treat. Advances in imaging, internal fixation, and arthroplasty have resulted in improved management of these injuries. Preoperative CT with three-dimensional reconstruction allows a better understanding of fracture patterns and helps the surgeon to select the best treatment options. Parallel plating techniques often provide stable internal fixation constructs, even in fractures with severe comminution. Precontoured periarticular plates facilitate internal fixation. More attention is now paid to recognizing and managing bone loss through metaphyseal shortening and/or bone grafting. Elbow arthroplasty appears to provide good early outcomes for elderly patients with severe elbow injury. Distal humeral hemiarthroplasty can be considered for elbow fractures with severe damage to the articular surface if the patient is too young and active to comply with the restrictions recommended after total elbow arthroplasty. Advances are still needed to reduce the overall complication rates associated with the treatment of distal humeral fractures.