Distal Humerus Fractures
What is it?
A distal humerus fracture is a break in the lower end of the upper arm bone (humerus), one of the three bones that come together to form the elbow joint. A fracture in this area can be very painful and make elbow motion difficult or impossible.
Most distal humerus fractures are caused by high—energy events, such as receiving a direct blow to the elbow during a car collision. However, in an older person who has weaker bones, even a minor fall may be enough to cause a fracture.
Treatment for a distal humerus fracture usually involves surgery to restore the normal anatomy and motion of the elbow.
What are the causes?
Distal humerus fractures are most often caused by:
⦁ Falling directly on the elbow
⦁ Receiving a direct blow to the elbow from something hard, like a baseball bat or a dashboard or car door during a vehicle collision
⦁ Falling on an outstretched arm with the elbow held tightly to brace against the fall.
⦁ Pathological fracture
What are the symptoms?
A distal humerus fracture may be very painful and can prevent you from moving your elbow.
Other signs and symptoms of a fracture may include:
⦁ Swelling
⦁ Bruising
⦁ Tenderness to the touch
⦁ Stiffness
⦁ A feeling of instability in the joint, as if your elbow is going to “pop out.”
⦁ In rare cases, the fractured bone may stick out of the skin (open fracture)
Treatment
Nonsurgical Treatment
Although rare, nonsurgical treatment may be recommended for stable fractures in which the pieces of bone are not out of place (displaced). It may also be recommended for patients who are at higher risk for surgical complications.
Splints are typically worn for six weeks before supervised motion is started. If the fracture shifts out of position during this time, you may need surgery to put the bones back together.
Surgical Treatment
Surgery is usually required for distal humerus fractures in which:
⦁ The bones have moved out of place (displaced fracture)
⦁ Pieces of bone have punctured the skin (open fracture)
Because of the increased risk of infection, open fractures are scheduled for surgery as soon as possible, usually within hours.
Surgical Procedures
Open reduction and internal fixation
This is the procedure most often used to treat distal humerus fractures. During the procedure, the bone fragments are first repositioned (reduced) into their normal alignment and then held in place with plates and screws attached to the outside of the bone.
External fixation
For severe open fractures, We may apply an external fixator to hold the bones in place until a second surgery can take place.
Total elbow replacement (arthroplasty)
In some cases, the humerus is so severely damaged that it cannot be adequately fixed and needs to be replaced.
In an elbow replacement, a metal and plastic implant is attached to the humerus after removing the broken bits of bone. Another metal and plastic implant is attached to the ulna (forearm bone), and the two implants are connected to form a hinge. These implants may be held in place with bone cement.
