Published online Jul 28, 2026. doi: 10.5528/wjtm.122418
Revised: June 7, 2026
Accepted: June 18, 2026
Published online: July 28, 2026
Processing time: 102 Days and 15.2 Hours
Distal humerus fracture-related infections (FRIs), particularly those involving the articular surfaces of the elbow, pose a significant challenge as they can lead to severe upper limb functional impairment and systemic complications. Distal humerus fractures represent about 2% of all fractures and approximately 30% of all elbow fractures. Such kind of infections are reported in literature with rates from 4% to 14.5% of distal humerus fractures treated with open reduction and internal fixation. We analyzed current evidence on distal humerus FRIs and report our clinical approach aimed at achieving both fracture healing and in
To present a consecutive series of distal humerus FRIs, and to synthesize tre
We performed a retrospective analysis of 43 patients with distal humerus FRIs treated at our institution between 2017 and 2022. Patients were stratified ac
Among patients with healed fractures (n = 6), implant removal and debridement resulted in infection eradication in all cases (100%). In early/delayed infections (n = 6), DAIR achieved both fracture union and infection control in 100% of cases. In patients treated with implant removal for unhealed fractures (n = 19), infection eradication and fracture healing were achieved in 14 cases (73.7%), while 5 patients (26.3%) required conversion to total elbow arthroplasty. In cases managed with implant retention and suppressive antibiotic therapy (n = 12), infection control was maintained until fracture union in all patients. Mean follow-up was 45 months. DAIR was effective in resolving acute and delayed infections. For late infections, both eradication and suppression yielded satisfactory outcomes.
The literature on the management of distal humerus FRI is limited. Although limited by the small sample size and absence of a control group, the manuscript describes our approach to managing distal humerus FRIs, which could contribute to improved patient outcomes.
Core Tip: This study evaluates the management of distal humerus fracture-related infections in 43 patients, highlighting the effectiveness of tailored surgical and antibiotic strategies. Our results demonstrate that debridement, antibiotics, and implant retention is highly successful for early and delayed infections. For late infections or unhealed cases, we found that implant removal and suppressive therapy are effective alternatives. Based on these findings, we propose a clinical decision-making algorithm centered on fracture healing status and infection timing to guide surgeons in achieving both infection eradication and bone union.