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of the Adult's Elbow > Fracture of the Distal Humerus in the Adult What is a Fracture of the Distal Humerus? The humerus is the long bone in the upper arm, a relatively thick bone with a large, smooth head at the proximal end (where it meets the shoulder) and a number of projections (or processes) at the distal end, the area of the elbow. A fracture of the distal humerus is a fracture in the lower portion of the arm near the elbow. At the distal end of the humerus are two projections known as condyles, the medial epicondyle and the lateral epicondyle. These bumps in the bone are attachment sites for muscles that move the forearm. Fractures to the distal humerus usually involve both condyles and often extend into the elbow joint. There may be damage to the humerus, the elbow joint, and to soft tissue around the fracture site, including nerves, tendons, ligaments, and blood vessels. Several classification schemes exist for distinguishing among fractures. The most useful way to understand them is to consider them as either nondisplaced or displaced. Nondisplaced fractures are less severe, and the fracture does not separate. Displaced fractures may involve both condyles as well as the surface of the elbow joint. The bone fragments separate completely and need to be rejoined. If a fracture is comminuted there are more than two fragments of bone and the break is severe. Fractures of the distal humerus are relatively uncommon, accounting for only 2% of fractures in adults. However, they can be among the most difficult fractures to treat and bring to complete recovery. Causes of a Fracture of the Distal Humerus? A fracture of the distal humerus may be the result of a fall or direct blow onto the back of the upper arm when the elbow is held in a flexed position. It may be occur during high-energy trauma, such as a car accident. The old Burma-Shave roadside signs said, “Elbows held out of the window far, often go home in another car.” To help prevent fractures, it is wise to learn how to brace yourself during a fall, to use care while exercising and walking, and to wear shoes that offer both good support and adequate traction, and to keep your elbow inside of the car window. Protect the elbow with appropriate pads and protective gear during sports such as roller-blading and football. Symptoms of a Fracture of the Distal Humerus? If the distal humerus is fractured you will experience pain, especially when you try to flex your elbow. The injured site will be swollen. You may not be able to fully extend your elbow. Blood vessels may have ruptured, causing ecchymosis, a purple discoloration of the skin. If the bone fragments have separated enough to distort the normal contour of the arm, there will be visible deformity. The radial pulse may be lost to palpation. Treatment of a Fracture of the Distal Humerus? As in the case of any suspected fracture, seek medical care as soon as possible. Many tissues quickly lose their elasticity and must be promptly treated in order to assure maximum healing. Immediately after injury, use blankets to decrease the possibility of shock. Cut away clothing, if possible, but do not move the injured arm to do so. Follow directions for R.I.C.E.:
Your doctor will examine the arm for neurovascular damage and take x-rays of the injured area, including the joints above and below the primary injury site. He or she will ask for details about how the injury occurred, and will need to know about previous conditions of the arm, hand, and shoulder. Both the wrist and shoulder will be checked for related injuries. The skin around the elbow will be examined for open wounds, a sign of a compound or open fracture. X-rays will reveal details about the injury. If there is no radiographic image of a fracture, your doctor will look for evidence of bleeding into the elbow joint, a sign of an occult or hidden fracture. He or she will examine the tendons and muscles of the upper arm, to be sure that they have not ruptured. To treat a nondisplaced fracture, your doctor will align the arm in a healing position with a splint, usually worn for at least ten days. If the fracture is displaced, surgery is required for internal stabilization of the bone fragments. The aim of surgery is to secure the bone internally with plates or a combination of wire and pins or screws. Appropriate analgesia is used and outpatient pain medication is prescribed. Acetaminophen is often recommended for mild pain. Surgical risk increases with smoking and/or the use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers, and corticosteroids. To assure rehabilitation of the arm, follow the instructions given to you by your doctor. You will probably be asked to keep your arm elevated in order to reduce and control swelling. If possible, arrange your bed so that your upper body is elevated while you sleep. Eat highly nutritious foods, including extra protein (meat, fish, poultry, legumes, tofu, milk, eggs, cheese) and fiber. Your doctor may advise you to use an ice pack 3 or 4 times a day. Place ice cubes or chips in a plastic bag, wrap the bag in a moist towel, and place it over the injury for 20 minutes at a time. If heat feels better it can be applied instead, using a heat lamp, heating pad, hot soaks or showers, or heat liniments and ointments. Treatment with a whirlpool can also be very helpful. Your doctor will tell you when you can begin reconditioning the arm. He or she will provide you with range-of-motion exercises that help facilitate a complete recovery. Use ice massage for ten minutes before and after doing these exercises. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top of the cup so the ice protrudes, and massage firmly over the injured area in a circle about the size of a baseball. Do this for 15 minutes at a time, 3 or 4 times a day. Resume normal activities gradually after treatment, remembering that complete healing may take weeks or even months, depending on the seriousness of the injury. Healing is considered complete when there is no sign of motion at the fracture site and when x-rays show complete union of the bone. The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician. © 2000 DynoMed.com, LLC, Indianapolis, IN |