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Distal Humerus Fracture
Aka: Distal Humerus Fracture, Lateral Epicondyle Fracture, Lateral Condyle Fracture, Medial Epicondyle Fracture, Medial Condyle Fracture, Transcondylar Fracture, Capitellar Fracture, Capitellum Fracture
- See Also
- Supracondylar Fracture
- Proximal Humerus Fracture
- Humerus Shaft Fracture
- Epidemiology
- Distal Humerus Fractures account for one third of Humerus Fractures and up to 2% of overall Fractures in adults
- 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
- Symptoms
- Elbow Pain and Swelling
- 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
- 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)
- Grading: AO/OTA Classification
- Extraarticular Fracture (A)
- Avulsion Fracture (A1)
- Lateral Epicondyle (A1.1)
- Medial Epicondule (A1.2)
- Simple Fracture (A2)
- Spiral Fracture (A2.1)
- Oblique Fracture (A2.2)
- Transverse Fracture (A2.3)
- Wedge Fracture or Multifragmentary Fracture (A3)
- Intact Wedge Fracture (A3.1)
- Fragmentary Wedge Fracture (A3.2)
- MultiFragmentary Fracture (A3.3)
- Partial Articular (B)
- Lateral Sagittal Fracture (B1)
- Simple Transtrochlear Fracture (B1.1)
- Capitellar Fracture (B1.2)
- Transcapitellar Fracture (B1.2q)
- Between capitellum and trochlea (B1.2r)
- Fragmentary Transtrochlear Fracture (B1.3)
- Medial Sagittal Fracture (B2)
- Simple Trochlear Groove Fracture (B2.1)
- Simple Medial Trochlear Ridge Fracture (B2.2)
- Fragmentary Transtrochlear Fracture (B2.3)
- Frontal or Coronal Fracture (B3)
- Complete Articular (C)
- Simple Articular Fracture and Simple Metaphyseal Fracture (C1)
- Simple Articular Fracture and Fragmentary Metaphyseal Fracture (C2)
- Multifragmentary Articular Fracture (C3)
- 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
- Bicolumnar Fracture in the elderly
- Significant articular involvement (e.g. C3 Fracture)
- Severely comminuted elbow Fractures
- Complications
- Compartment Syndrome
- Radial Nerve Injury at the Elbow
- Brachial Artery Injury
- Open Fracture
- Resources
- Distal Humerus Fractures (AO Surgery Reference)
- https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/distal-humerus
- Distal Humerus Fractures (Radiopaedia)
- https://radiopaedia.org/articles/aoota-classification-of-distal-humeral-fractures?lang=us
- References
- Briones and Huang (2021) Crit Dec Emerg Med 35(7): 12-3