Distal Humerus Fracture

synonyms: supracondylar humerus fracture, intercondylar humerus fracture, T condylar humerus fracture, transcondylar humerus fracture, Y condylar humerus fracture, distal humerus fracture

Distal Humerus Fx ICD-9

• 812.40 (fracture of humerus, lower end, unspecified, closed)
• 812.41 (fracture of humerus, supracondylar, closed)
• 812.51 (fracture of humerus, supracondylar, open)
• 812.50 (fracture of humerus, lower end, unspecified, open)

Distal Humerus Fx Etiology / Epidemiology / Natural History

• Generally from a fall onto the posterior elbow, fall onto outstretched hand, or MVA.
• Bimodal distribution: patients in second decade with high-energy trauma and elderly patients with low-energy falls.

Distal Humerus Fx Anatomy

• Distal humerus is composed of a medial and lateral columns separated by the trochlea.
• Medial column diverges from the humeral shaft at @45º angle.
• Lateral Column diverges from the humeral shaft at @20º angle.
• Trochlea has a 300º arch of cartilage.
• see also Elbow Anatomy.

Distal Humerus Fx Clinical Evaluation

• Pain, swelling, deformity, loss of motion.
• Document NV exam.
• Evaluate for compartment syndrome.

Distal Humerus Fx Xray / Diagnositc Tests

• A/P, lateral and oblique views of the elbow demonstrate fracture.
• CT scan: typically indicated do to complexity of most distal humerus fractures. 3D reconstructions with radius and ulna subtracted are beneficial.

Distal Humerus Fx Classification / Treatment

• AO Classification
• Non-displaced: rare, consider non-op management if CT scan confirms <2mm articular displacement.
• Displaced: ORIF . (Sanchez-Sotelo J, JBJS 2007;89:961).
• Elderly (>70y/o) / low funtional demand / inflammatory arthritis: TEA (Cobb TK, JBJS 79A:826;1997), (Frankle MA, JOT 2003;17:473), (Kamineni S, JBJS 2004;86A:940) (McKee MD, JSES 2009;18:3). Recommend permanent 5 pound lifting restriction to avoid loosening.
• Distal Humerus ORIF Technique

Distal Humerus Fx Associated Injuries / Differential Diagnosis

• Elbow dislocation
• Olecranon fracture
• Radial head fracture

Distal Humerus Fx Complications

• Superficial wound infection
• contracture
• Nonunion
• Hardware failure
• Malunion
• Painful hardware
• Ulnar nerve palsy
• Radial nerve palsy
• Heterotopic ossification

Distal Humerus Fx Follow-up Care

• Post-op: Posterior splint, NWB.
• 7-10 Days: Remove splint, begin passive shoulder and elbow ROM. Stress elbow ROM. Active flexion, gravity extension.  Active extension avoided for 6wks. Generally start physical therapy for ROM and strengthening
• 6 Weeks: Begin active extension, strengthening exercises provided fracture union is evident on xray.
• 3 Months: Ensure full restoration of shoulder and elbow ROM. Consider bone stimulator if union is delayed. Sport specific rehab.
• 6 Months: return to full activities / sport.
• 1Yr: Follow-up xrays, assess outcomes.
• Outcome after ORIF of intra-articular fx’s= Mean flexion contracture-25 degress, mean arc of motion-108 degrees, @75% of normal strength.  24% reoperation usually for HWR (McKee JBJS 2000;82A:1701).
• Elbow Outcome measures.

Distal Humerus Fx Review References

• Galano GJ, JAAOS 2010:18:20
• Zohlman GL, in Masters Technique in Orthopedics - Fractures, 2005
• Rockwood and Green's Fractures in Adults 6th ed, 2006
• Anglen J, JAAOS 2005;13:291

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Bonefoam

Smith&Nephew Elbow

Synthes Distal Humerus

Zimmer Small Frag set

Zimmer Periarticular