The Orthobullets Podcast Podiums | Trauma | Distal Humerus Fractures: Fix or Replace?
Aug 18, 2025
In this discussion, Dr. Michael McKee, an orthopedic surgeon known for his expertise in distal humerus fractures, delves into the intense debate on whether to fix or replace these injuries. He shares insights from recent research highlighting optimal treatment options, particularly in osteopenic patients. The talk covers challenging surgical strategies, potential complications during recovery, and the importance of managing patient autonomy following total elbow arthroplasty. Tune in for a fascinating look at cutting-edge techniques in orthopedic surgery!
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COTS Trial Shaped Practice But Debate Continues
- McKee's 2009 COTS trial shaped practice by favoring TEA in elderly osteopenic fractures.
- Since then, fixation techniques evolved while TEA innovation lagged, reopening the debate.
Fix Young Patients, Not Replace
- For a 50-year-old male with comminuted distal humerus fracture, McKee recommends open reduction and internal fixation, not TEA.
- Prioritize wound debridement, address posterior triceps wound, and use double plating with small fragment fixation.
Prefer Triceps-Sparing Exposures
- Consider triceps-sparing approaches when possible to avoid olecranon osteotomy morbidity.
- Use the triceps split/peel or two-window Rosenwasser approach to preserve the extensor mechanism when feasible.