II. Epidemiology
- Distal Humerus Fractures account for one third of Humerus Fractures and up to 2% of overall Fractures in adults
III. Mechanism
- Fall on Outstretched Hand
- Direct blow to elbow
- Typically a high energy injury in adolescents and young adults
- Also occurs in elderly with falls
IV. Symptoms
- Elbow Pain and Swelling
V. Exam
- See Trauma Evaluation
- See Elbow Exam
- Avoid evaluating elbow range of motion in known Distal Humerus Fracture
- Risk of neurovascular injury
- Perform Hand Neurovascular Exam
- Radial Nerve Injury at the Elbow is most common associated neurologic injury
VI. Imaging
- Precautions
- Consider other XRays above and below the Fracture based on exam and mechanism
-
Elbow XRay
- Obtain Anteroposterior (AP) and Lateral Views
- Consider traction view
- Evaluates for intraarticular Fracture by reducing overlapping bone
-
Elbow CT
- Indicated to prepare for open reduction and internal fixation (ORIF)
VII. Grading: AO/OTA Classification
- Extraarticular Fracture (A)
- Partial Articular (B)
- Complete Articular (C)
VIII. Management
- Closed reduction as indicated
- Perform under Procedural Sedation, Regional Anesthesia or Hematoma Block
- Reevaluate neurovascular exam and imaging after any Fracture reduction or manipulation
- Immobilization
- Posterior Long Arm Splint
- Elbow flexed to 90 degrees
- Forearm in neutral position
- Emergent Orthopedic Consultation Indications
- Neurovascular compromise (e.g. Radial Nerve injury at elbow, brachial artery injury)
- Acute Compartment Syndrome
- Open Fracture
- Orthopedic Close Interval Follow-up (within 3-5 days)
- Most cases require surgical management
- Open Reduction with Internal Fixation with contoured locking plates (most common)
- Typically offers excellent functional outcomes
- Total Elbow Arthroplasty or Hemiarthroplasty Indications
IX. Complications
- Compartment Syndrome
- Radial Nerve Injury at the Elbow
- Brachial Artery Injury
- Open Fracture
X. Resources
- Distal Humerus Fractures (AO Surgery Reference)
- Distal Humerus Fractures (Radiopaedia)
XI. References
- Briones and Huang (2021) Crit Dec Emerg Med 35(7): 12-3
Images: Related links to external sites (from Bing)
Related Studies
Concepts | Injury or Poisoning (T037) |
ICD10 | S42.4 |
SnomedCT | 367415002, 157209004, 17359008, 208290000, 263192005 |
English | Frac distal end of humerus, Fracture/lower end of humerus, fracture of distal end of humerus (diagnosis), fracture of distal end of humerus, fracture of humerus distal end, Fracture of lower end of humerus (disorder), Fracture of distal end of humerus, Fracture of lower end of humerus, Fracture of distal end of humerus (disorder), fracture; humerus, distal end, humerus; fracture, distal end, Fracture of distal end of humerus, NOS, Fracture of lower end of humerus, NOS, Fracture of lower end of humerus (disorder) [Ambiguous] |
German | Fraktur des distalen Endes des Humerus |
Korean | 위팔뼈 하단의 골절 |
Spanish | fractura del extremo distal del húmero (trastorno), fractura de extremo distal de húmero, fractura del extremo inferior del húmero (trastorno), fractura de extremo distal de húmero (trastorno), fractura del húmero distal (trastorno), fractura del húmero distal, fractura del extremo inferior del húmero, fractura del extremo distal del húmero, fractura del extremo inferior del húmero (concepto no activo), fractura del húmero distal [dup] (trastorno) |
Dutch | fractuur; humerus, distaal uiteinde, humerus; fractuur, distaal uiteinde, Fractuur van ondereinde van humerus |
Ontology: Fracture of the medial humeral epicondyle (C0559419)
Concepts | Injury or Poisoning (T037) |
SnomedCT | 281526006 |
English | Fract medl humeral epicondyle, fracture of humerus distal end medial epicondyle, fracture of medial epicondyle of humerus (diagnosis), fracture of medial epicondyle of humerus, Fracture of the medial humeral epicondyle, Fracture of the medial humeral epicondyle (disorder) |
Spanish | fractura de epitróclea (trastorno), fractura de la epitróclea (trastorno), fractura de epitróclea, fractura de la epitróclea, fractura del epicóndilo humeral interno |
Ontology: Transcondylar fracture of distal humerus (C2711651)
Concepts | Injury or Poisoning (T037) |
SnomedCT | 441496000 |
English | Transcondylar fracture of distal humerus (disorder), Transcondylar fracture of distal humerus |
Spanish | fractura transcondílea de húmero distal, fractura transcondílea de húmero distal (trastorno) |