The humerus is the long bone of the arm. The top of the humerus is part of the shoulder joint, and the bottom is part of the elbow joint. A distal humerus fracture is a break involving the lower part of the humerus that articulates with the elbow. These fractures are less common, require a higher energy mechanism to occur, and are more complex to repair.
A distal humerus fracture can occur after a fall off the bike or a road traffic accident. It can also happen after a simple fall on the elbow.
Symptoms of a distal humerus fracture include:
• Elbow pain
• Swelling and bruising in the elbow
• Numbness in the hand if any of your nerves are stretched or bruised (typically the ulnar nerve, the so called “funny bone”)
• Inability to bend or straighten the elbow
The doctor will see you, take a detailed history and perform a physical exam focused on your neurovascular status, taking care not to cause any further pain and discomfort. An x-ray is usually sufficient to confirm the diagnosis. Your doctor is likely to request further imaging, typically a CT scan, to help with preoperative planning.
If your break is minimally displaced, or if you have many medical problems and you are not a candidate for surgery, your distal humerus fracture may be treated conservatively. However, conservative treatment for distal humerus fractures (the so called “bag of bones” treatment) has been largely abandoned nowadays, as results have been pretty bad. Most distal humerus fractures today need and get surgery. Surgery involves an incision in the back of your elbow through which the surgeon puts the bones back together and fixes them with plates and screws (ORIF). Sometimes, especially in the elderly, if the fracture is very comminuted, the bone quality is not good and the bones are not fixable, an elbow replacement is more appropriate. This can be a total elbow arthroplasty or a hemiarthroplasty, based on the surgeon’s preference. In any case after surgery, early mobilization is encouraged to avoid stiffness and regain the normal elbow range of motion. Your surgeon and physiotherapist will create an individualized rehabilitation program for you.
Distal humerus fractures can be pretty spicy and difficult to fix, and they should be treated by an experienced elbow surgeon. Dr Panagopoulos has extensive surgical experience in complex elbow surgery and will discuss in depth the procedure with you during your visit in the office.
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