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

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.