Distal Humerus Fracture Fixation

Indications

Posterior Approach (Using Olecranon Osteotomy), radiograph of a distal humerus fracture after fixation
Radiograph of a distal humerus fracture after fixation. Image by Mehlauge, Wikimedia Commons, Public domain.
  • Displaced intra-articular fractures in adults
  • Total elbow arthroplasty for comminuted osteoporotic fractures in older patients (McKee, JSES 2009)
  • Non-operative care (bag of bones) only for very frail patients
  • Open fractures need debridement and fixation

Position

  • Lateral or prone with the arm over a bolster
  • Tourniquet high on the arm
  • Image intensifier from the head end

Operative Steps

  1. Posterior midline incision
  2. Identify and protect the ulnar nerve, transpose if needed
  3. Chevron olecranon osteotomy with the apex distal, or triceps sparing approach
  4. Reduce and fix the articular block first
  5. Fix the articular block to the shaft with parallel or orthogonal plates
  6. Maximise long screws in the distal fragment that interlock (O Driscoll principles)
  7. Fix the osteotomy with a plate or tension band
  8. Pre-drill the osteotomy before cutting
  9. Restore the trochlea width and the anterior angulation of the articular block

Postoperative Care

  • Early active motion
  • Indomethacin or radiotherapy is considered for heterotopic ossification risk
  • Elevation and splint for 2 to 3 days
  • Avoid resisted extension until the osteotomy unites

Complications

  • Ulnar neuropathy
  • Stiffness and heterotopic ossification
  • Nonunion of the fracture or osteotomy
  • Hardware prominence
  • Infection
  • Hardware prominence over the olecranon
  • Post-traumatic arthritis

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.