Fractures/Injuries

What is a Distal Humerus Fracture of the Elbow?

The elbow is a region between the upper arm and the fore arm. The elbow joint is made up of 3 bones. The distal (lower) end of the humerus bone in the upper arm joins with the radius and ulna bones in the fore arm to form the elbow joint. The elbow joint is very important for the movement of your arms and for coordination of daily activities. Injury in the distal humerus can cause impairment in the function of the elbow joint. Distal humerus fracture is a rare condition which occurs when there is break in the lower end of the humerus. The treatment of distal humerus fracture aims at restoration of normal anatomy.

Causes of Distal Humerus Fractures

A distal humerus fracture may result due to a fall. This occurs more often when you land directly on your elbow during the fall or when you get struck by a hard object. It can also happen when you fall on your outstretched arm with the elbow locked straight.

Symptoms of Distal Humerus Fractures

Distal humerus fractures are usually very painful. The common symptoms are swelling, bruising, stiffness, tenderness, severe pain and inability to move the arm.

Diagnosis of Distal Humerus Fractures

Distal humerus fractures are generally considered an emergency condition. Your doctor might examine the skin to check for any cuts and feel it to determine the presence of broken bones or injuries. Your doctor might recommend an X-ray examination to determine the depth (intact or broken bones) of the fracture.

Treatments of Distal Humerus Fractures

Distal humerus fractures can be treated by both non-surgical and surgical methods based on the intensity of the fracture.

Nonsurgical Treatment

If the fracture has not caused displacement of the bone, then your doctor might apply a splint (a casting) and you may be required to wear a sling until complete healing and recovery occurs.

Surgical Treatment

Your doctor might recommend surgery if the fracture has led to the displacement of bone and pieces of the bone have exited the skin. During surgery, the displaced bone or pieces of bone are joined together with the help of metal screws and plates. You may also be given antibiotics to avoid the risk of infection.

Prevention of Distal Humerus Fractures

Care should be taken while you walk or run and especially while climbing up/down the stairs. This can prevent you from falling and eventually from accidental fractures.

What are Radial Head Fractures of the Elbow?

The elbow is a junction between the forearm and the upper arm. The elbow joint is made up of 3 bones namely the humerus bone in the upper arm which joins with the radius and ulna bones in the forearm. The elbow joint is essential for the movement of your arms and to perform daily activities. The head of the radius bone is cup-shaped and corresponds to the spherical surface of the humerus. The injury in the head of the radius causes impairment in the function of the elbow. Radial head fractures are very common and occur in almost 20% of acute elbow injuries. Elbow dislocations are generally associated with radial head fractures. Radial head fractures are more common in women than in men and occur more frequently in the age group of 30 and 40 years.

What are the Causes of Radial Head Fractures

The most common cause of a radius head fracture is breaking a fall with an outstretched arm. Radial head fractures can also occur due to a direct impact on the elbow, a twisting injury, sprain, dislocation or strain.

Symptoms of Radial Head Fractures

The symptoms of a radial head fracture include severe pain, swelling in the elbow, difficulty in moving the arm, visible deformity indicating dislocation, bruising and stiffness.

How are Radial Head Fractures Diagnosed?

Your doctor might recommend an X-ray to confirm the fracture and assess displacement of the bone. Sometimes, your doctor might suggest a CT scan to obtain further details of the fracture, especially the joint surfaces.

What are the Treatment Options for Radial Head Fractures?

The treatment of a fracture depends on the type of fracture.

• Type 1 fractures are usually very small. The bone appears cracked, but remains fitted together. The doctor might use a splint (casting) to fix the bone and you might have to wear a sling for a few days. If the crack becomes intense or the fracture gets deep, then your doctor might suggest surgical treatment.
• Type 2 fractures are characterized by displacement of bones and breaking of bones in large pieces and can be treated by surgery. During surgery, your doctor will correct the soft-tissue injuries and insert screws and plates to hold the displaced bone together firmly. Small pieces of bone may be removed if it prevents normal movement of the elbow.
• Type 3 fractures are characterized by multiple broken pieces of bone. Surgery is considered the compulsory treatment to either fix or to remove the broken pieces of bone, sometimes including the radial head. An artificial radius head may be placed to improve the function of the elbow.

Elbow Fractures

The bones of the elbow are susceptible to injury and fracture just like any other part of the body. If a serious injury occurs, this may result in fracture of one or more of the elbow bones including the radial head, olecranon (tip of the elbow), or the distal portion of the humerus. The type and degree of disruption of the fracture typically dictate treatment, which may range from nonoperative and attempted early motion, to extensive surgery to restore the normal anatomy of the elbow.

What is a radial head fracture and how is it treated?

The most common elbow fracture involves the radial head, typically as a result of a fall onto an outstretched arm. This fracture results in pain and swelling within the elbow causing difficulty rotating the forearm as well as with straightening and bending the elbow. Commonly, these fractures can be treated without surgery by initiating motion exercises. However, if the fracture causes disruption of the joint surfaces (an intraarticular fracture) it may require fixation with surgery that uses screws to hold the bones in the correct anatomical position as it heals. Sometimes, the fracture is so severe that replacement of the bone is required with a metal implant, called a radial head arthroplasty.

What is an olecranon fracture and how is it treated?

The olecranon is the point of the elbow and is considered the proximal portion of the ulna. The triceps muscle, which is responsible for actively straightening the elbow (extension) attaches to the olecranon. This bone may be fractured from a direct fall onto the point of the elbow or a fall onto an outstretched hand. Most commonly, this fracture results in a significant disruption of the ability of the elbow to extend actively and requires surgery. Typically, this fracture is fixed with a plate and screws. Often after surgery, the patient is encouraged to begin active motion almost immediately.

What is a distal humerus fracture and how is it treated?

The distal humerus is the portion of the upper arm bone that makes one side of the elbow joint. This bone connects (articulates) with both the ulna and radius, and also functions as the origin for both of the major ligaments of the elbow, the MCL and LUCL. Typically, a distal humerus fracture results from either a fall or a high energy mechanism such as a car accident or fall from height. Often, these fractures involve the joint surface and most will require surgical fixation. The benefit of surgical fixation is restoration of the normal anatomy of the elbow, which also allows for immediate mobilization of the elbow that helps to prevent stiffness. Surgery for distal humerus fractures typically utilizes a surgical incision along the back of the elbow that allows for the placement of up to two plates and screws along the elbow to stabilize the fracture.

What are elbow fracture dislocations and how are they treated?

In very severe elbow injuries, the elbow may sustain a fracture of the bones with an associated disruption of the ligaments. This is a serious injury that results in major disruption of the elbow joint and if not treated appropriately may result in long term dysfunction of the elbow. These fractures are commonly known as “terrible triad” fractures, because they result in disruption of three structures: fracture of the radial head, fracture of the coronoid (the coronoid is a portion of the proximal ulna that helps to provide stability to the elbow joint), and disruption of the lateral ligament. In addition, they are termed “terrible” because if not addressed appropriately they can have poor outcomes.

Surgery is almost always required for these injuries to restore stability to the joint and allow for early motion to avoid stiffness. Surgery begins with an incision along the back or side of the elbow. The lateral ligament is identified and repaired to the humerus with suture. The radial head is fixed with screws unless it is highly damaged, then a replacement radial head is utilized. The coronoid fracture can be fixed with either suture or screws. Typically, the patient remains in the hospital overnight after surgery, and a drain may be placed into the surgical incision to remove extra bleeding. Depending on the stability of the repair, we try to allow the patient to move the elbow as soon as possible to prevent stiffness. Commonly, the patient is placed into an elbow brace that allows for motion but provides stability (hinged elbow brace). This is kept on for 6 weeks and then progressive weight bearing is initiated. Patients may improve with motion and strength for up to 1 year from surgery.