These are fractures of the distal segment of the humerus. Altogether they represent a 2.66% of the total series of surgically treated fractures that we have reviewed.

The surgical indication is clear when the fractures involve the joint, which must be anatomically reconstructed and the fragments stabilized in order to allow early motion, the key to a good result in the elbow joint.

In the metaphyseal fractures, the reduction is more important than in the diaphyseal fractures because the angular and torsional malalignments will directly influence the functional axis of the elbow. There is no external splint (ending at the axilla), however well molded, capable of maintaining the reduction of a fracture of the distal humerus; this is why the surgical indication seems to be the most adequate one.

The surgical technique is usually difficult and an osteotomy of the olecranon may be required to allow exposure for the reduction and internal fixation. The radial and median nerves are allways present in this area and the humeral artery is an added risk. The reduction of the articular surface must be meticulous and stable; small areas of bone loss must be substituted by autologous cancellous bone graft. The anatomical irregularities of the distal humerus require contouring of the implants and mastery of the large and small fragment techniques in order to combine them adequately. Surgery of the distal humerus is difficult and requires good quality X-rays for a detailed preoperative planning.