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What are Distal Humerus Fractures?

A distal humerus fracture is a condition that occurs when there is a break in the lower end of the humerus bone that commonly occurs as a result of severe trauma. Fracture of the distal humerus can affect the movement and function of your arm as well as your work and activities of daily living. Distal humerus fractures are common and occur in individuals of all ages from children to the elderly.

What does ORIF mean?

Open reduction and internal fixation (ORIF) is a surgical technique employed for the treatment of distal humerus fractures to restore normal anatomy and improve range of motion and function.

Anatomy 

The upper arm bone is called the humerus. The head of the humerus fits into a shallow socket in your scapula (shoulder blade) to form the shoulder joint.  The humerus narrows down into a cylindrical shaft and joins at its base with the bones of the lower arm to form the elbow joint.

Causes of Distal Humerus Fractures

Fracture of the distal humerus may be caused by:

  • A direct blow or injury
  • Fall on an outstretched arm
  • High-impact collision, such as a motor vehicle accident
  • Contact sports, such as football
  • Fall from a height

A distal humerus fracture can also occur as a result of a pathologic condition that weakens your bones, such as:

  • Bone infection
  • Osteoporosis
  • Tumors or bone cysts
  • Bone cancer

Signs and Symptoms of Distal Humerus Fractures

Common signs and symptoms of distal humerus fractures may include:

  • Pain
  • Swelling
  • Bruising
  • Tenderness
  • Stiffness
  • Inability to move the arm
  • Deformity

Diagnosis

Your doctor may examine the skin to check for any cuts and feel the area to determine the presence of broken bones or other injuries. An X-ray examination will be obtained to confirm the diagnosis. A CT scan may also be necessary to determine the extent of the injury.

Preparation for Surgery

Prior to surgery, you may have:

  • A physical exam to inspect blood circulation and nerves affected by the fracture
  • X-ray, CT scan, or MRI scan to assess surrounding structures and the broken bone
  • Blood tests
  • Depending on the type of fracture you have sustained, you may be given a tetanus shot if you are not up-to-date with your immunizations
  • A discussion with your doctor about the medications and supplements you are taking and the potential need to stop some of them if need be

Treatment for Distal Humerus Fractures

The management of a distal humerus fracture is comprised of non-surgical or surgical treatment. The choice of treatment depends on the type and severity of the fracture.

Non-surgical Treatment

The nonsurgical approach involves placing your arm in a sling to immobilize the bones and allow healing. Physical therapy may be needed to prevent stiffness and weakness of the shoulder and elbow, restore range of motion, and strengthen muscles.

Surgical Treatment

Open reduction and internal fixation is the procedure most commonly used to treat distal humerus fractures. The surgery is performed under sterile conditions in the operating room under general anesthesia. 

  • After sterilizing the affected area, your surgeon will make an incision around the upper arm or elbow. 
  • Your surgeon will locate the fracture by carefully sliding in between or through the muscles around the humerus
  • Your surgeon will put the fragments of your broken bone back into position (reduction). 
  • Next, your surgeon will secure the fragments of the humerus to each other (fixation) by using metal plates, screws, wires, or pins. 
  • After securing the bone in place, your surgeon will close the incisions with sutures or staples and cover it with a sterile dressing. A splint may also be applied to help protect the elbow.

Postoperative Care

You will have some pain after procedure and medication will be prescribed to help keep you comfortable. Your doctor will instruct you on dressings and incision care and applying ice to relieve pain and discomfort. 

Physical therapy may be necessary to prevent shoulder and elbow stiffness, strengthen muscles, and restore range of motion. You will also be advised on diet and supplements high in vitamin D and calcium to promote bone healing. You should avoid smoking or the use of any tobacco products during the healing process, as these can delay or prevent healing.

Depending on your health condition and the extent of the injury, you may be able to go home the same day with follow-up appointments for monitoring progress and for removal of the stitches or staples as necessary.

Risks and Complications

Risks and complications of open reduction and internal fixation of distal humerus fractures include:

  • Bleeding
  • Infection
  • Damage to nerves and blood vessels
  • Broken screws or plates
  • Anesthetic complications
  • Failure to heal
  • Avascular necrosis
  • Blood clots
  • Loss of range of motion

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