Distal Humerus Fractures

What is a Distal Humerus Fracture?

A distal humerus fracture is a fracture of the end of the long bone in the upper arm.  Distal humerus fractures can be some of the most challenging fractures to fix in the upper extremity due to the many forces acting on the elbow. Nearly all distal humerus fractures need to be fixed operatively. Because of the many forces acting on the distal humerus and elbow, strong plate fixation needs to be employed. Typically, these injuries are related to higher energy falls directly onto the elbow. These fractures are associated with higher than normal complication rates if left untreated.

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How is it Diagnosed?

Distal humerus fractures are most commonly diagnosed with x-rays.  Some fractures are evident from the deformity that is visualized just by looking at the injured limb.  However, all distal humerus fractures will at least get x-rays, most will need a CT scan to fully evaluate the morphology of the fracture and fracture pieces.

What are the Treatments?

Only a select few fractures can be managed non-operatively and only if they are completely non-displaced and have no angular deformity on x-ray. Typically treatment includes surgical fixation with plates and screws. Some fractures that only involve the joint surface can be fixed with special screws that are designed to lie beneath the joint surface.

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What Type of Surgery?

As outlined previously there are many techniques utilized by hand surgeons to fix distal humerus fractures. For fractures that involve more proximal and larger portions of the distal humerus, plates and screws are used to provide strong fixation. This usually requires a large incision centered over the posterior elbow. This allows for early elbow range of motion and less stiffness. Other fractures that require only a small articular fragment to be fixed can be fixed with special headless compression screws. This is usually achieved through a smaller lateral or medial incision depending on the location of the fracture fragments.

What to Expect?

If you have surgery you can expect to be immobilized for 7-10 days on average. Early range of motion will then be started by your occupational or physical therapist.  Swelling and stiffness are expected in the early postoperative phase. This typically improves after 6-8 weeks of therapy.  Patients are usually allowed to start weight bearing at 8 weeks after surgery or when bony union starts to become evident on x-rays. Patients are released to full activity depending on a variety of factors including bony union as evidenced on x-rays, pain with range of motion, and physician discretion. Usually people are ready to perform full activity around 12 weeks.

Hand Surgery