Distal humerus fracture fixation is an operation to repair a fracture of the lower end of the upper arm bone where it forms the elbow joint. These fractures often involve the joint surface and require precise reconstruction.
An incision is made at the back of the elbow. The ulnar nerve is identified and protected. If needed, the olecranon (elbow tip) is cut to allow access to the joint surface (olecranon osteotomy). The fracture fragments are anatomically reconstructed and fixed with plates and screws — usually two plates at right angles. The olecranon is repaired. The operation takes two to three hours.
Almost all displaced distal humerus fractures in adults require surgery because the joint surface must be accurately restored. Without surgery, the elbow heals stiff and painful.
Non-operative treatment with a cast or splint may be considered in elderly patients with significant medical comorbidities, accepting limited function. Total elbow replacement may be an alternative in elderly patients with severely comminuted fractures.
CT scan for planning. Surgery within days of injury.
Restoration of the elbow joint surface to allow a functional range of motion. Most patients achieve a useful arc of movement, though some loss of full extension is common.
Very common. Some loss of full extension is expected. Physiotherapy is critical.
Numbness or tingling in the ring and little fingers, usually temporary.
Plates may be palpable and may require removal.
Unwanted bone formation limiting movement. Preventive medication may be given.
Failure to heal. May require further surgery.
Permanent nerve damage requiring transposition.
Deep infection around metalwork.
Arthritis may develop over time.
General anaesthesia with regional arm block.
Early movement is critical. Physiotherapy begins within the first few days. Splinting between exercise sessions for protection. Return to desk work at four to six weeks. Full recovery six to twelve months. Some permanent loss of extension is common.
Regular X-rays at two weeks, six weeks, and three months.
Most patients achieve a functional range (approximately 30-130 degrees). Some loss of full extension is common but rarely causes functional problems.
The elbow is very prone to stiffness after injury and surgery. Early, supervised movement prevents scar tissue from forming and locking the joint.