Stevens Nicole M
Bull Hosp Jt Dis (2013). 2021 Mar;79(1):43-50.
Distal humerus fractures are a challenging problem that has vexed many orthopedic surgeons through the years. This article reviews the historical management of distal humerus fractures from nonoperative treatment to prolonged traction with ice tongs to the advent of AO technique and beyond. Current controversies, including plate orientation, ulnar nerve management, and the role of arthroplasty, are reviewed. Based on the best available evidence, parallel plating has been shown to be biomechanically superior, but no differences have been found in clinical outcomes, and the surgeon should let the fracture pattern dictate plate placement. The evidence surrounding ulnar nerve management is controversial, but a systematic review has shown no benefits to routine transposition. Finally, total elbow arthroplasty is an excellent option in geriatric fractures with osteoporotic bone and should be considered in these cases. Ultimately, distal humerus fractures, especially in the geriatric population, remain a difficult problem, but with meticulous technique and stable restitution of the bony columns and tie arch, good outcomes can be obtained.
肱骨远端骨折是一个具有挑战性的问题，多年来一直困扰着许多骨科医生。本文回顾了肱骨远端骨折从非手术治疗到使用冰钳长时间牵引，再到AO技术出现及以后的历史治疗方法。对当前的争议，包括钢板的放置方向、尺神经的处理以及关节成形术的作用进行了综述。基于现有最佳证据，平行钢板在生物力学上已被证明更具优势，但在临床结果方面未发现差异，外科医生应根据骨折类型决定钢板的放置位置。关于尺神经处理的证据存在争议，但一项系统评价表明常规转位并无益处。最后，全肘关节置换术对于伴有骨质疏松性骨的老年骨折是一个极佳的选择，在这些病例中应予以考虑。最终，肱骨远端骨折，尤其是在老年人群中，仍然是一个难题，但通过细致的技术操作以及对骨柱和连接弓的稳定复位，可以获得良好的治疗效果。
