Distal Humerus Fracture
A distal humerus fracture occurs when there is a break anywhere within the distal region (lower end) of the humerus. The bone can crack just slightly or break into many pieces (comminuted fracture). The broken pieces of bone may line up straight or may be far out of place (displaced fracture).
In some cases, the bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the bone. This is called an open fracture. Open fractures are particularly serious because, once the skin is broken, infection in both the wound and the bone is more likely to occur. Immediate treatment is required to prevent infection.
Distal humerus fractures are uncommon; they account for just about 2 percent of all adult fractures. They can occur on their own, with no other injuries, but can also be a part of a more complex elbow injury.
DISTAL HUMERUS ANATOMY
Tenderness to the touch
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)
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. In this situation, the ulna (one of the forearm bones) is driven into the distal humerus and this causes it to break.
Distal humerus fractures are also sometimes caused by weak bone. This is most common in older patients whose bones have become weakened by osteoporosis. In these patients, a fracture may occur even after a minor fall.
Treating a humerus fracture depends on several factors, including the type of fracture and whether there are any loose bone fragments. To determine the best treatment, your doctor will start by taking an X-ray of your arm. They may also have you do some movements with your arm. This will help them determine what kind of fracture you have and whether you have any other injuries.
In many cases, proximal and mid-shaft humerus fractures don’t require surgery because the broken ends usually stay close together. This makes it easier for your humerus to heal on its own. However, you’ll still need to wear a sling, brace, or splint to keep your arm from moving and stabilize your shoulder, if needed. Occasionally, surgery is required with either plates, screws, rods, or sometimes replacement of your shoulder joint with use of a prosthesis.
Distal fractures and more severe proximal or mid-shaft fractures usually require surgery. There are two main approaches that your surgeon may use:
Pins and screws. If you have an open fracture, which involves a piece of bone sticking through your skin, surgery will be required to clean up the broken ends and they may use pins and screws and plates to hold the broken ends of your humerus in place.
Bone grafting. If some of the bone has been lost or severely crushed, your surgeon may take a piece of bone from another area of your body or a donor and add it to your humerus. In some cases, doctors can even use an artificial material to create a new piece of bone.
Regardless of whether or not you need surgery, your doctor will probably suggest following up with physical therapy. This will help you learn exercises and movements you can do to help strengthen your arm muscles and regain your range of motion.
CONTACTING DR. PERLMUTTER
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