JSES - 2026-05-21 - Journal Article
Surgical treatment for posterior distal humeral shear fractures.
Xia X, Zha Y, Jiang X
Topics
Key Takeaway
ORIF of posterior distal humeral shear fractures achieved 100% excellent-to-good MEPS outcomes (mean 95±5 points) at mean 25-month follow-up in 13 patients.
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Summary
This study characterized the morphology, injury mechanism, and surgical outcomes of posterior distal humeral shear fractures in 13 patients treated with ORIF between 2021 and 2024. Twelve of 13 fractures involved the posterior capitellum; valgus posterolateral rotational injury was the dominant mechanism (10/13 cases). At final follow-up, mean MEPS was 95±5, mean flexion-extension arc was 127°±13°, and fracture healing occurred at 12±2 weeks with a 100% excellent-to-good rate.
Key Limitation
Series of 13 patients from a single center with no comparative cohort, making it impossible to determine whether outcomes reflect fracture biology, surgical technique, or patient selection.
Original Abstract
BACKGROUND
Posterior shear fractures of the distal humerus are rare and have a complex,controversial injury mechanism.
OBJECTIVE
To investigate the morphological characteristics,injury mechanisms,and treatment outcomes of posterior shear fractures of the distal humerus.
METHODS
From March 2021 to October 2024, 13 patients with posterior shear fractures of the distal humerus were treated with open reduction and internal fixation. Among them, 7 were male and 6 were female, with a mean age of 40 years (range: 25-66 years). Five cases involved the left side, and 8 involved the right side. All fractures were closed. Most cases (n=12) were posterior capitellar shear fractures, with only one case of posterior trochlear shear fracture. Ten cases were caused by valgus posterolateral rotational injury, and three were caused by varus posteromedial rotational injury. A lateral approach was used in most cases (n=9), followed by a combined medial and lateral approach (n=4), with the medial side addressed via an over-the-top approach. Fractures were fixed using anchor screws, Herbert screws, coronoid plates, and Kirschner wires. All the patients were evaluated using the Mayo Elbow Performance Score (MEPS) during the follow-up.
RESULTS
All patients were followed up for a mean of 25 months (range: 12-38 months). The mean fracture healing time was 12 ± 2 weeks. Postoperative complications included degenerative osteoarthritis of the elbow (n=1), heterotopic ossification (n=1), and ulnar neuropathy symptoms (n=1). At the final follow-up, the mean elbow flexion-extension arc was 127° ± 13°, the forearm rotation arc was 173° ± 5°, and the MEPS was 95± 5 points. Results were rated as excellent (n=12) and good (n=1), with an excellent-to-good rate of 100%.
CONCLUSION
Posterior shear fractures of the distal humerus mostly involve the posterior of the capitellum and are often associated with elbow dislocation. These fractures are primarily caused by valgus posterolateral rotational injury force. Surgical management should therefore include the repair of both the fracture and the stabilizing ligamentous structures.