Chevron Osteotomy for Intra-Articular Distal Humerus Fracture: An Evidence-Based Case Report with Systematic Review

Abstract

Intra-articular distal humerus fractures are complex injuries that require anatomical reduction, stable internal fixation, and adequate surgical exposure to restore elbow function. Chevron osteotomy is widely used to improve visualization of the distal humeral articular surface during open reduction and internal fixation (ORIF). To present the management of an intercondylar distal humerus fracture using the chevron osteotomy approach and synthesize the available evidence regarding its clinical outcomes. An evidence-based case report with a systematic literature review was conducted following the PRISMA framework. A comprehensive search of PubMed, Cochrane Library, and ScienceDirect identified studies published between 2009 and 2025 using the keywords chevron osteotomy, distal humerus fracture, distal humeral fracture, intercondylar humerus fracture, trans-olecranon approach, open reduction internal fixation (ORIF), fixation, and surgical approach. Of 458 records identified, eight studies met the eligibility criteria and were included in the qualitative synthesis. Most included studies reported good-to-excellent functional outcomes, with mean Mayo Elbow Performance Score values generally exceeding 80 points, together with high rates of fracture union and osteotomy healing. Although implant-related irritation was the most frequently reported complication, osteotomy nonunion and fixation failure were uncommon. These findings were consistent with the presented case, in which chevron osteotomy facilitated anatomical reduction and stable fixation. Chevron osteotomy remains an effective surgical approach for complex intra-articular distal humerus fractures, providing excellent articular exposure, reliable union, and favorable functional outcomes when combined with accurate reduction and stable fixation.