Treatment of supracondylar humerus and femoral shaft fractures has changed over time, leading to a decrease in the associated incidence of compartment syndrome following these injuries. Various common injuries in the shoulder, humerus, and elbow are investigated in this section. We found in our series of 11 patients that undisplaced fractures. Proximal means it is the end of the bone that is closest to the body. An integer programming model for distal humerus fracture. The anatomy of the distal humerus is highly complex, as it articulates with both the. Pdf management of distal humerus fractures researchgate. Midshaft humeral fractures, aka humeral shaft fracture or diaphyseal humerus fractures, are a break somewhere in the middle section of the bone. Distal humerus orif fracture early motion therapy protocol. In cases of highly comminuted articular fractures in a low 1. From ring et al for very distal comminuted fractures type 1 capitellum and lateral trochlea type 2 is a type 1 with comminution of lateral condyle type 3 is a type 2 with comminution behind capitellum with impaction type 4 is a type 3 with trochlea posterior involvement type 5 is a type 4 with fracture of medial condyle.
Precountoured locking compression plates have more benefits. Typically supracondylar fractures occur as a result of a fall on a hyperextended elbow. Review article elastic stable intramedullary nailing of. Distal humerus fractures although less common, are on an increasing trend over the last few decades 1. Bony healing occurs usually within 6 to 8 weeks in adults 2. Pediatric and adolescent ttype distal humerus fractures. A pitfall in fixation of distal humeral fractures with pre. A proximal humerus fracture is a crack or break in the top of your upper arm bone. Girls tended to sustain these fractures more often.
Before the age of two, the low supracondylar fracture is an entity to beware of, as the largely unossified distal humeral chondroepiphysis renders radiological. The distal humerus is composed of the medial and lateral columns, lateral epicondyles, and the articular surface. The majority of such fractures result from highenergy trauma, and these types of fractures. Distal humerus fractures constitute 2% of all fractures in the adult population. Fractures of the distal humerus in the adult comprise approximately one third of all humeral fractures. There are three locations that humerus fractures occur.
A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. Distal humerus fractures orthopaedic trauma association. Throwers fracture of the humerus mdedge emergency medicine. They result in an extraarticular fracture line, and when displaced posterior displacement of the distal component. Transposition of the ulnar nerve allows us to use the cubital tunnel as a point for fixation. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture. Fractures of the adult distal humerus compromise 2% of all fractures. This volume clearly explains the concepts that are central to an understanding of humeral fractures from the proximal to the distal tip. Fractures of the humerus are classified based on the location of the fracture and then by the type of fracture. Fractures of the distal humerus are complex injuries that can be effectively treated with open reduction and internal fixation orif.
A fracture in this area can be very painful and make elbow motion difficult or impossible. Distal humerus fracture fixation, surgical preplanning, computer assisted orthopaedic surgery introduction distal humeral fractures account for less than 1% of adult fractures. These types of elbow fractures are fairly uncommon. Return to normal function and motion may require 3 to 4 months overall goals. Stabilization of these fractures is difficult because the distal fragments are small and a large portion of their surface is covered with articular cartilage. Two common techniques for this approach are the triceps splitting and the olecranon osteotomy techniques. Fractures occurring proximal to the lateral columns are termed fractures of the distal third of.
From ring et al for very distal comminuted fractures. The anatomically shaped and angular stable fixation system for extraarticular fractures of the distal humerus. Type 2 is a type 1 with comminution of lateral condyle. The distal fracture fragments are often posteriorly displaced. We describe 3 patients ages 27, 49, and 73 years with a bicolumnar fracture of the distal humerus where very short distal. It may occur as part of a posterolateral or posterior dislocation of the elbow. Overview distal humerus fractures are traumatic injuries that include supracondylar fractures. Riseborough and radin compared conservative and surgical management of these fractures and.
Pdf surgical fixation of extraarticular distal humerus fractures with. It extends from your shoulder to your elbow, where it joins with the ulna and radius bones of your forearm. Approximately onethird of humeral fractures occur in this region. Proximal humerus fracture book twin cities orthopedics. Supracondylar humeral fracture radiology reference.
Bennett fracture dislocation fractures of the hand intraarticular fracture of the proximal end of the first metacarpal, with dorsal and lateral dislocation of the distal segment. Operative treatment of type c intercondylar fractures. An avulsion fracture of the lateral epicondyle is an extremely rare injury in adults. Distal humeral fractures msd manual professional edition. Although historically, these injuries have been treated. Pdf treatment of distal humerus fractures with extra. Pdf fractures of the distal humerus are complex injuries that can be effectively treated with open reduction and internal fixation orif. Intraarticular fractures of the distal humerus supracondylar fractures of the distal humerus nonunions of the distal humerus osteotomies of the distal humerus. Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. Distal upper extremity fractures case type diagnosis. The distal humerus is the end of the upper arm bone the humerus that forms the upper part of the elbow. This standard applies to patients who have sustained upper extremity fractures that require stabilization either surgically or nonsurgically.
The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. Elbow fractures are typically associated with traumaa fall or motor vehicle accident are common causes. Intraarticular distal humerus fractures orthopedic clinics. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. Olecranon osteotomy approach for complex aoc fractures. Extraarticular fractures of the distal humerus malunions of the distal humerus nonunions of the distal humerus.
Esin, humerus, proximal, shaft, distal, fracture, children, operative, complications. Distal humerus fracture open reduction and internal fixation. Incidence age is the key factor in the incidence of supracondylar fractures. Gartlands classification of supracondylar fracture of humerus. Significant attention is paid not only to proper diagnostic examination and imaging, but. Introduction humerus fractures are relatively uncommon in childhood except for supracondylar humerus fractures. Pdf distal humerus fractures are a challenge in diagnosis, surgical intervention, and rehabilitation.
A patients guide to distal humerus fractures of the elbow. These injuries interfere with the ability of the elbow to place the hand in a functional position. The proximal humerus is one of the bones in your shoulder joint. From ring et al for very distal comminuted fractures type 1 capitellum and lateral trochlea type 2 is a type 1 with comminution of lateral condyle type 3 is a type 2 with comminution behind capitellum with impaction type 4 is a type 3 with trochlea posterior involvement type 5 is a type 4 with fracture. The usual injury mechanism is a fall on an outstretched arm with the elbow extended or direct force, often causing posterior. A distal humerus fracture is a break in the lower end of the upper arm bone humerus, one of the three bones that come together to form the elbow joint.
The distal humeral trochlea provides a very narrow anatomical window through which to pass a fixedangle locking screw, which must also avoid the olecranon, coronoid, and radial fossae. The former is the preferred technique of the plate designers. A proximal humerus fracture is when the bone is broken at or near the top, by the shoulder. Appointments no pt for 3 weeks, unless otherwise specified by md rehabilitation goals modalities to control pain and swelling protect fracture. A distal humerus fracture is one type of elbow fracture.
In contrast, intraarticular fractures of the distal humerus are frequently complex and full functional recovery is difficult to achieve. Distal humeral fractures are common among children aged 3 to 11 years. Introduction fractures of the distal end humerus possess a challenge owing to unique anatomical features and dearth for its approach. Supracondylar humerus fractures that historically were treated with closed. Although fractures of the elbow are extremely common in pediatric patients, the ttype distal humerus fracture is rare and offers unique challenges. Article information, pdf download for fractures of the distal humerus. Distal humerus fractures of the elbow orthoinfo aaos.
After age 15, it is a rare fracture, distal humeral fractures tending to be of a more adult pattern, frequently involving the articular surfaces and extending proximally into the diaphysis. We help you diagnose your distal humerus case and provide detailed descriptions of how to manage this and hundreds of other pathologies. Fashion removable longarm splint holding the elbow in 90 degrees of. A distal humerus fracture can be a debilitating and difficult injury to treat. A fracture in this area can be very painful and make. Distal humerus fracture, fracture fixation, open reduction internal fixation, total elbow arthroplasty, anatomy, elbow. A humerus fracture refers to any break in this bone. Most supracondylar fractures are extension injuries, resulting from falls on outstretched arms. A throwers fracture is a rare fracture pattern characterized by a spontaneous fracture of the mid to distal third of the humeral diaphysis during an attempted throwing motion. Exposure of a complex intraarticular fracture may best be. The intercondylar fracture pattern is the most common type. Significant attention is paid not only to proper diagnostic examination and imaging, but also to optimal nonoperative and operative treatment options to manage these conditions.