Distal Humerus Fractures
A distal humerus fracture is a break in the upper arm. These are relatively rare fractures, involving only 2 percent of all fractures. They usually occur among boys in their teens and in females older than age 80. The most common injury in the elderly involves falling from a standing height. Most fractures involve the intercondylar area, which is the part of the bone between the two condyles that make up the elbow joint. The humerus can also break nearer to the shoulder joint, these kinds of breaks are referred to as proximal humerus fractures and is a common injury to the shoulder.
In older people, the fracture can happen with a minimal fall. In younger individuals, these broken bones are more commonly associated with high-velocity collisions such as found in motor vehicle accidents and sporting injuries.
If you or a family member has sustained a distal humerus fracture from an accident that was caused by someone else, you may be able to file a personal injury claim for compensation. Call us at (916) 921-6400 for free, friendly advice.Evaluation of Humeral Fractures
There is often a lot of swelling associated with these fractures. It can be hard to identify the landmarks around the elbow. There will be a lot of crepitus in these injuries but it is not a good idea to push much on the fracture site to find crepitus because it involves pushing on nerves and blood vessels that can be damaged during the assessment process. The fracture must be re-evaluated on a regular basis for compartment syndrome from excessive swelling and for neurovascular compromise.
X-rays in two views (front and side) will be able to tell if the bone is fractured in most cases. Sometimes an oblique view is necessary. Nondisplaced fractures may just show swelling of the fat pad in the elbow joint, often called the “sail sign” because of its triangular shape. CT scan can be used if it is not clear exactly where the fracture fragments are located.Classification of Humerus Fractures
There are many types of distal humerus fractures, including:
- Supracondylar fractures (extension or flexion type)
- Transcondylar fractures
- Intercondylar fractures
- Capitellum fractures
- Condylar fractures
- Trochlea fractures
- Lateral epicondyle fracture
- Medial condylar fracture
- Fractures of the supracondylar process
The idea behind the treatment of distal humerus fractures is to put the joint surfaces in as close approximation as possible and to stabilize the articular surface. The alignment of the joint must be in its proper position and there must be early range-of-motion exercises to keep the joint from becoming stiff. Such exercises will occur during physical therapy.
Treatment can be non-operative or operative, depending on the conditions. If they are treated non-operatively, this can mean ongoing arthritis and limited function of the elbow after the bones have healed. This is more commonly done in the elderly who already have poor expectations of normal function of the elbow, regardless of the type of treatment. Often the fractures are comminuted so that it is difficult to put the bony fragments back into position. A long arm splint is used at 90 degrees flexion for about 1-2 weeks after which range of motion exercises can be done with the elbow in a brace for about 6 weeks.
Surgery is required if the fragments are widely displaced or if there is an open fracture. If the blood vessels have been damaged and blood supply is reduced, then surgery is required to repair the injury. Sometimes closed reduction is attempted and surgery is done if the closed reduction fails.
Plates are used at 90 degrees or 180 degrees from one another and the plates are held on with screws. In some cases, a total elbow replacement needs to be done but this is not often attempted in the elderly population. Range-of-motion exercises can be used to keep the joint from freezing up. These are usually attempted after the pain and swelling have diminished—about 1-2 weeks after the injury.Complications of a Distal Humerus Fracture
There can be unrecognized compartment syndrome that doesn’t allow for complete vascularity to the forearm so that contractures of the elbow occur. There can be a loss of range of motion of the elbow, particularly loss of complete extension of the elbow due to callus formation in the inner aspect of the elbow. Extra bone can grow at the site of the fracture, which can contribute to loss of function of the elbow.
Post-traumatic arthritis can happen whenever the joint itself is involved. This can be minimized by surgically aligning the fracture fragments so that the joint heals. It can also be improved by doing early range-of-motion exercises to keep the joints from stiffening. Joint spurs can form in certain types of fractures, which limit the range of motion of the elbow.Photo by Deposit PhotosEditor’s Note: This page has been updated for accuracy and relevancy [cha 4.3.20]