Treatment algorithm for intraarticular fractures of the distal humerus
1. Closed management
Intraarticular fractures of the distal humerus that are either undisplaced or minimally displaced (step or gap) can be treated closed by plaster cast immobilization.
In some particular cases, where secondary displacement (ie, increasing of the step or the gap) is of concern, a percutaneous K-wire, or cannulated screw fixation can be indicated.
In case of immobilization of an undisplaced fracture, a cast-free control x-ray should be obtained within one week to exclude secondary displacement. If the fracture remains undisplaced, then nonoperative treatment (cast immobilization) can be continued.
If fracture displacement has occurred, or there are signs of elbow joint instability, open reduction and stabilization are required.
2. Open management
All intraarticular fractures with significant initial displacement (step and/or gap) should be treated by open reduction and stabilization by an appropriate technique.