Think about sitting at the computer and not being able to type or extend or flex your arm to reach for objects. A distal humerus fracture of the elbow can make it impossible and affect other functions in your everyday life. Distal humerus fractures of the elbow are typically associated with a trauma that causes the fracture and can be extremely painful. If someone experiences such a suspected fracture, it is essential to seek immediate help from an orthopedic specialist. At the Colorado Center of Orthopedic Excellence in Colorado Springs, Colorado, they can determine if you have suffered a distal humerus of the elbow so that you get the exact and expert help you need.
A distal humerus fracture of the elbow 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. Distal humerus fractures of the elbow are uncommon; they account for just about 2% of all adult fractures. They can occur on their own, with no other injuries, but can also be part of a more complex elbow injury. These injuries interfere with the ability of the elbow to place the hand in a functional position. While many distal humerus fractures in children can be treated non-operatively, the majority of fractures in adults will require surgery.
ABOUT THE ELBOW
The elbow joint is a hinge joint that serves two distinct functions; bending and straightening the elbow and turning the palm up and palm down. The elbow is made up of three bones: the humerus (upper arm bone), the radius (forearm bone on the thumb side), and the ulna (forearm bone on the pinky side). The humerus is the long bone in the upper arm. The top of the bone is part of the shoulder joint, and the bottom is part of the elbow joint. There are many muscles surrounding the humerus bone: the biceps and brachialis muscles are in the front, and the triceps muscle is in the back. There are also nerves, arteries, and veins going up and down along the bone. The lower end of the humerus bone is called the distal part or “distal humerus.” The distal humerus has cartilage at the end of it, which is part of the upper part of the elbow joint. There is a large nerve on the inner side of the distal humerus and elbow called the ulnar nerve. This is the nerve that causes pain and the feeling of pins and needles when you hit your “funny bone.”
WHAT IS A DISTAL HUMERUS FRACTURE OF THE ELBOW?
This fracture occurs when there is a break anywhere within the distal region (lower end) of the humerus. The bone can crack just slightly or break into many pieces (comminuted fracture). The broken pieces of bone may line up straight or be far out of place (displaced fracture). In some cases, the bone breaks in such a way that bone fragments stick out through the skin, or a wound penetrates down to the bone. This is called an open fracture. Open fractures are particularly serious because once the skin is broken, infection in both the wound and the bone is more likely to occur.
Distal humerus fractures of the elbow are most often caused by:
- Falling directly on the elbow
- Receiving a direct blow to the elbow from something hard, like a baseball bat
- A vehicle collision smashing into a dashboard or car door
- Falling on an outstretched arm with the elbow held tightly to brace against the fall. In this situation, the ulna (one of the forearm bones) is driven into the distal humerus, and this causes it to break
- Sometimes they are caused by weak bones. This is most common in older patients whose bones have become weakened by osteoporosis. In these patients, a fracture may occur even after a minor fall.
- Tenderness to the touch
- Inability to move the arm as usual
- A feeling of instability in the joint, as if the elbow is going to “pop out”
- In rare cases, the fractured bone may stick out of the skin
Nonsurgical treatment may be recommended for stable fractures in which the pieces of bone are not out of place. It may also be recommended for patients who may not be able to have surgery due to a medical condition like osteoporosis. Initial treatment will consist of a splint (like a cast) or a sling to help keep the elbow in position. While the arm is in the sling it is essential to keep the fingers, wrist, and shoulder moving to prevent stiffness. Ice can reduce pain and swelling. Pain relief medications such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to manage pain and reduce swelling. Physical therapy can be crucial for maintaining joint mobility and preventing stiffness.
WHEN IS SURGERY INDICATED?
The choice between non-surgical and surgical treatments depends on various factors, including the specific characteristics of the fracture, the patient’s overall health, and the expected functional outcomes. Surgery is usually required for distal humerus fractures of the elbow in which the bones have moved out of place (displaced fracture) or pieces of bone have punctured the skin (open fracture). Open reduction and internal fixation is the procedure most often used to treat distal humerus fractures. During the procedure, the bone fragments are first repositioned (reduced) into their normal alignment and then held in place with plates and screws attached to the outside of the bone. For severe open fractures, external fixation may be used, and a second surgery may be required.
GETTING THE RIGHT DIAGNOSIS. GETTING THE RIGHT DOCTOR.
Getting a correct diagnosis of a distal humerus fracture of the elbow needs to happen as soon as possible after the injury because of complications that can occur if not treated right. These include malunion, when your broken bones don’t line up correctly, or nonunion where your bones may not grow back together fully or at all. You can trust the experienced orthopedic specialists at the Colorado Center of Orthopedic Excellence in Colorado Springs, Colorado, to know exactly what to do when this type of injury is suspected. In many cases, X-rays alone may adequately provide enough information to determine treatment. However, additional imaging for bone, such as computerized tomography (CT scans) or MRIs, may yield additional helpful information. Distal humerus fractures of the elbow can be complex, which is why you want surgeons with the most extensive experience treating distal humerus fractures of the elbow. At CCOE, you can count on getting not just the most caring and skilled care, but the very best outcome. Schedule an appointment with an elbow specialist today.