Challenges in selecting surgical approaches for intra-and juxta-articular fractures of the distal humerus

Fractures of the distal metaepiphysis of the humerus are relatively common injuries affecting the bones of the elbow joint. These fractures are often associated with soft tissue damage, including tendon and muscle injuries, which is a typical feature of trauma to these structures. In current trauma practice, surgical methods are preferred for distal humerus fractures, typically involving open reduction of bone fragments and stable functional osteosynthesis. However, despite advances in surgical techniques for managing long bone fractures, the disability rate following distal humerus fractures remains high, particularly among individuals of working age. The choice of an optimal surgical approach is a critical factor in osteosynthesis of this fracture type, as it must minimize soft tissue trauma while providing adequate visualization of the bone fragments. Despite extensive experience in managing these fractures, the global orthopedic community still lacks a unified algorithm for selecting the most appropriate surgical approach for distal humerus osteosynthesis. This review aims to summarize data from the international literature on various aspects of managing distal humerus fractures, with a particular focus on surgical approaches and criteria for selecting the optimal treatment strategy. © 2025 Elsevier B.V., All rights reserved.