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. 2024 Apr 24;59(1):3-18.
doi: 10.1007/s43465-024-01141-3. eCollection 2025 Jan.

Treatment of Extra-Articular Distal Humerus Fractures: Current Concepts and Systematic Review

Andrea Attenasio  1 , Nikki A Doerr  1 , Ian S Hong  1 , Christian G Zapf  1 , Jaclyn M Jankowski  1 , Frank A Liporace  1 , Richard S Yoon  1 , Nicole Montero-Lopez  1
Affiliations

Treatment of Extra-Articular Distal Humerus Fractures: Current Concepts and Systematic Review

Andrea Attenasio et al. Indian J Orthop. .

Abstract

Background: Acute extra-articular distal humerus fractures (DHFs) continue to pose a treatment challenge for many orthopedic surgeons. The aim of this study was to provide a comprehensive review of treatment principles, while reporting union rates, time to union, complication rates, and outcome measures following operative and non-operative management.

Methods: A systematic review was conducted utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies reporting clinical or functional outcomes following treatment for acute DHFs in patients > 17 years of age with a mean follow-up of 6 months or greater were included. Methodological Index for Non-Randomized Studies (MINORS) criteria was used to assess risk of bias.

Results: A total of twenty articles were included with 754 fractures. The union rates after operative management were 97% (95% CI: 93-99%) compared to 99% (95% CI: 85-100%) after non-operative management. The most common patient reported outcome for operative studies was Mayo Elbow Performance Score (range 65-100). Range-of-motion (ROM) was the most common reported outcome in the non-operative studies. Complications rates after operative management were 13% (95% CI: 8-20%) compared to 8% (95% CI: 2-32%) in patients treated conservatively.

Conclusions: This systematic review is among the largest studies reporting on union rates, complication rates, and functional outcomes of acute extra-articular DHFs following operative and non-operative management. There is a need for up-to-date and high-quality comparative studies to establish a definitive gold standard treatment based on patient profiles and management goals.

Level of evidence: Level IV.

Keywords: Distal humerus; Extraarticular; Management; Systematic review.

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Conflict of interest statement

Conflict of InterestThe authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
A Pooled union rates for operative management (top) and assessment of publication bias (bottom). B Pooled union rates for non-operative management (top), adjusted pooled union rates after excluding Weening et al. in a sensitivity analysis (middle) and assessment of publication bias (bottom)
Fig. 3
Fig. 3
A Pooled complication rates for operative management (top) and assessment of publication bias (bottom). B Pooled complication rates for non-operative management (top) and assessment of publication bias (bottom)
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